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Anthem Blue Cross reimbursement policy updates effective November 1

November 05, 2013
Area(s) of Interest: Commercial Payors Payor Issues and Reimbursement Practice Management 


<p>In late July, Anthem Blue Cross sent physicians a notice advising of upcoming changes to the insurer&rsquo;s reimbursement policies and claims editing software called ClaimsXten. The changes went into effect on November 1, 2013. Along with the notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem&rsquo;s reimbursement policies.</p>
<p>Changes include: denial of 3D rendering CPT codes 76376 and 76377; assistant surgeon and co-surgeon codes eligible for payment; qualitative drug screen codes eligible for payment; frequency edits on certain codes; denials on invalid match of diagnosis and procedure code; several changes pertaining to durable medical equipment frequency and rental; and denials of attended sleep studies billed with place of service of 21 (home), among others.</p>
<p>Physicians are encouraged to review the claims editing changes as well as the corresponding detailed payment policies and reimbursement rates to understand how the changes will affect their individual practices.</p>
<p>Physicians can also access information on the changes via the <a href="https://provider2.anthem.com/wps/portal/ebpmybcc">Blue Cross website</a>. (Select &ldquo;Reimbursement Policies and McKesson ClaimsXten Rules&rdquo; under the &ldquo;What&rsquo;s New&rdquo; section.)</p>
<p>Questions about any of the claims editing rules or payment policies can be directed to Blue Cross Provider Care Department at (800) 677-6669.</p>

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