Now Available: Edit Transparency Tool!
What is it?
The Clear Claim Connection (C3) code edit transparency tool is operated by a third party (McKesson) and is designed to help providers determine how coding combinations are evaluated by the McKesson ClaimCheck® coding software during claim processing.
What’s the benefit?
Not only does the C3 tool make it possible for providers to proactively determine how ClaimCheck code edit policies will apply to their BCBSAZ claims, it also provides detailed edit rationale with references to national coding standards and guidelines.
What do I need to do to access the tool?
If you are already a registered provider portal user, check your “My Account” link to make sure you have been assigned a user role with claims access. If you would like to change your user role, please work with your Administrator or Office Manager.
The tool is accessed in the “Claims Management” section under the “Claims Tools” header, by clicking on the “Code Edit Updates” link.
How does the tool work?
Please view the C3 User Guide for an overview of the functions and easy-to-follow instructions for accessing and using the tool.
What else do I need to know about the tool?
The information received via the C3 tool does not constitute coverage, medical advice or guarantee of payment. It is not meant to prescribe, designate or limit procedures or medical care to members. If there is a difference between information received on C3 and the member’s benefit program, the member’s benefit program will govern. The C3 tool is not configured to display information from the BCBSAZ Medical Coverage Guidelines.
Code Edit Expansion
Previously we applied the following edits to certain surgery, radiology, pathology, laboratory, maternity and dental claims.
- Mutually Exclusive Services
- Incidental Services
- Modifier Validation
- Unbundled Services
- Age Conflicts / Gender Conflicts
- Multiple Surgery Reductions
- Duplicate Deny and Duplicate Rebundling
Effective June 25, 2016, we began applying the types of code edits listed above to all professional and outpatient medical claims. We also expanded our code edits to include the following:
- Correct Coding Initiative (CCI) Professional Edits
- Pre- and Post-Operative E&M Services within the Global Period
- Medical Visit Edits
What does this mean for me?
BCBSAZ’s coding edits will now be more in line with industry standards. The details of the CCI professional edits are available to be viewed at CMS.gov. Details of all edits are available in the C3 tool.