Blue Cross, BCN provide updated clinical editing billing tips

Blue Cross Blue Shield of Michigan and Blue Care Network publish clinical editing billing tips to help our health care providers avoid claim delays and denials.

We use nationally recognized clinical editing programs that compare procedure codes billed against nationally accepted coding and billing standards to check for clinical appropriateness and data accuracy.

We communicate new clinical editing policies and provide reminders for some clinical edits that are already in place, so providers can correctly report performed procedures, and we can pay claims accurately and timely with minimal delays.

This Clinical editing billing tips document includes the following tips:

• CLIA-waived tests for Medicare Plus Blue℠ claims
• Critical care in the ER when patient is discharged to home in the same encounter
• ICD-10-CM 7th character and therapy codes clinical editing update for Medicare Advantage claims
• Outpatient services during an inpatient stay are not separately reimbursable
• Procedure not carried out reminder
• Prostate specimen re-bundle
• Robotic/computer assistance and 3D imaging
• Sexually transmitted infection testing to be bundled
• More information about clinical editing