2018 Code Edit News

What will be changing in 2018?

Later in 2018, we will be replacing the ClaimCheck® coding software with the ClaimsXten® coding software (powered by Change Healthcare). ClaimsXten provides a technically advanced editing solution with greater flexibility and customization options, while still applying all of the same coding rules to professional and outpatient claims.

What does this mean for me?

There will not be significant changes in how the current coding rules are applied to claims other than a few minor enhancements that will bring these edits even more in line with industry standards. Details of all edits are available in the C3 tool.

C3 code edit transparency tool to be updated in 2018

What is the C3 tool?

The Clear Claim Connection (C3) code edit transparency tool is operated by a third party (Change Healthcare) and is designed to help providers determine how coding combinations are evaluated by the Change Healthcare ClaimCheck® or ClaimsXten® coding software during claim processing (the tool is not available for dental code edits).

What will be changing?

The current version of the C3 tool makes it possible for providers to proactively determine how ClaimCheck or ClaimsXten code edit policies will apply to their BCBSAZ claims. It also provides edit rationale with references to national coding standards and guidelines. 

The C3 tool is targeted to be updated later in 2018. The enhanced version of the C3 tool will allow providers to enter more information and receive greater detail in the responses. 

How do I access the C3 tool?

Access the tool in the secure provider portal at “Provider Resources > Guidelines > Claim Coding > Code Edit Information and C3 Tool.”  On the Code Edit Information page, scroll down to the C3 section and select one of the orange buttons to get started:

How do I use the tool?

The tool is simple and easy to use. See the C3 Provider User Guide for an overview of the functions and step-by-step instructions.

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.

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