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San Francisco Marin Medical Society Blog

Anthem Blue Cross Delays Payment Policies Changes and Claims Editing Software Transition

As previously reported, Anthem Blue Cross notified physicians in August of upcoming changes to the insurer’s reimbursement policies and claims editing software, ClaimsXten. While the notice advised physicians that most changes would go into effect on December 8, 2012, Blue Cross announced in November that implementation of these changes has been delayed until early 2013.

Along with the August notice, Anthem provided a comprehensive grid outlining all new, revised and existing reimbursement policies and claims editing rules as well as copies of Anthem’s reimbursement policies.

Updates include: assistant surgeon and co-surgeon codes eligible for payment, frequency edits on certain codes, multiple surgery reductions for certain endoscopic procedures performed on the same day, application of multiple procedure reduction for the technical component of certain diagnostic imaging procedures performed on same day, restrictions on payment for prolonged services codes 99354 and 99355 and denial of certain screening services (e.g.,Q0091, G0101, G0102) when billed with preventive or problem focused evaluation and management codes.

Once these changes are implemented, physicians may notice a difference in how certain codes and code pairs are adjudicated. Physicians are encouraged to review 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 the information in the mailer via the Blue Cross website, (Log into the provider portal and 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 Blue Cross Provider Care Department at (800) 677-6669.

SFMS members requiring assistance with billing and reimbursement issues can contact our member-only help line at (888) 401-5911 or

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