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Two New ClaimsXtenTM Rules to be Implemented in 2020

February 6, 2020

We will soon update our ClaimsXten software database to better align coding with the reimbursement of claim submissions.

Update Schedule

On April 20, 2020, we will update two rules:

  • Bilateral Services for Professional Claims
  • Modifier to Procedure Validation

Update Details

Bilateral Services for Professional Claims


This rule identifies claim lines where the submitted procedure code was already billed with a modifier –50 for the same date of service.

The same service performed bilaterally should not be billed twice when reimbursement guidelines require the code to be billed once with a bilateral modifier.

The rule denies the second submission.

Reminder:

Modifier 50 is used to report bilateral procedures that are performed during the same operative session. The use of modifier 50 is applicable only to services and/or procedures performed on identical anatomic sites, aspects, or organs. This modifier can be used for diagnostic, radiology, and surgical procedures.

Modifier 50 should not be used when the code descriptor indicates unilateral or bilateral and should not be used when RT and LT would be applicable to the services.

For correct billing, enter the bilateral procedure code with modifier 50 on one line with one (1) unit of service.

Modifier to Procedure Validation


This rule identifies claim lines with an invalid modifier to procedure code combination.

It denies procedure codes when billed with a modifier that is not likely or appropriate for the procedure code billed.

When multiple modifiers are submitted on a line, all are evaluated and if at least one is found invalid with the procedure code, the line is denied.


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.