Two New ClaimsXtenTM Rules to be Implemented June 2020

February 25, 2020

On or after June 15, 2020, we will update two rules within the ClaimsXten software database to better align coding with the reimbursement of claim submissions.

Lifetime Event


This rule audits claims to determine if a procedure code has been submitted more than the total number of times it is clinically possible or reasonable to perform a procedure on a single member.

The Lifetime Event is the total number of times that a procedure may be submitted in a lifetime. After reaching the maximum number of times, additional submissions of the procedure are denied.

Multiple Medical Same Day Visits


This outpatient facility rule identifies and recommends the denial of claims with multiple Evaluation & Management (E&M) codes and other visit codes that are:

  • Submitted on the same date of service,
  • Performed at the same facility,
  • Submitted with the same revenue code, and
  • Where the second and subsequent E&M code submitted lacks the required modifier – 27.

 

To determine how coding combinations may be evaluated during claim adjudication, use Clear Claim ConnectionTM (C3). Refer to the Clear Claim Connection page for answers to frequently asked questions about ClaimsXten and details on how to gain access to C3.

ClaimsXten and Clear Claim Connection are trademarks of Change Healthcare, an independent company providing coding software to BCBSOK. Change Healthcare is solely responsible for the software and all the contents. BCBSOK makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Change Healthcare. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.