August 01, 2016
Area(s) of Interest: Commercial Payors Health Information Technology Payor Issues and Reimbursement
Anthem Blue Cross recently notified physicians of upcoming changes to the insurer’s reimbursement policies and claims editing software, called ClaimsXten. The changes will go into effect on October 1, 2016, with the exception of policies for Multiple Diagnostic Ophthalmology Procedures (CA–0050) and Multiple Diagnostic Cardiovascular Procedures (CA-0051), which become effective on October 17, 2016. Because of these changes, physicians may notice a difference in how certain codes and code pairs are adjudicated.
The notice included a comprehensive grid outlining the new, revised and existing reimbursement policies and claims editing rules, as well as copies of Anthem’s reimbursement policies.
The changes include the addition of policy on daily unit maximums for certain drugs and biologic substances (CA-0048), including injections for infliximab (Remicade) and bevacizumab (Avastin). The new policy identifies the maximum number of billable units that the health plan has established as the daily dose maximum. Units reported over and above the dose maximum will not be eligible for reimbursement.
Physicians are encouraged to review all of the claims editing changes as well as the corresponding detailed payment policies to understand how the changes will affect their individual practices.
Physicians can also access this information via the Blue Cross ProviderAccess website (log in, then select “Reimbursement Policies and McKesson ClaimsXten Rules” under the “What’s New” section).
Questions about any of the claims editing rules or payment policies can be directed to the Blue Cross Provider Care Department at (800) 677-6669.