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Notice: Implementation of ClaimCheck® to our Medicare Advantage Plans effective March 7, 2011

Blue Cross and Blue Shield of North Carolina (BCBSNC) is continually reviewing ways to further improve our claims processing accuracy and consistency by employing the latest in proven computer technology.

We are pleased to announce BCBSNC is extending the implementation of ClaimCheck® to our Medicare Advantage Plans effective March 7, 2011.

ClaimCheck is a code editing system that assists in evaluating the accuracy of submitted CPT® and HCPCS codes. ClaimCheck uses a clinical knowledge base that results in a medically based recommendation to accept code(s) as submitted, change the codes to comply with generally accepted coding practices, or seek additional information from the physician's office.

ClaimCheck is a product currently used by BCBSNC on its other platforms and is now being extended to our Medicare Advantage platform to further improve our claims processing accuracy. The implementation is not expected to impact how claims are submitted or the methods of claim payment, however, there is a possibility that a claim could be bundled differently, resulting in a slightly higher or lower reimbursement.

Per the terms of your Agreement, units of service shall be determined by BCBSNC and may include specific CPT codes, bundled groups of CPT codes, specific diagnoses, and/or specific time periods. BCBSNC will use its best efforts to apply bundling logic that is consistent with industry AMA HCPCS (Level I and Level II) or CMS CCI standards in effect at the time of the date of service.

Thank you for your continued support and the quality care you provide to our members. If you have any questions or concerns please contact your regional Network Management representative by phoning one of the following numbers:

Office Telephone number Office Telephone number
Charlotte (800) 754-8185 Hickory (877) 889-0002
Greensboro (888) 298-7567 Raleigh (800) 777-1643
Greenville (888) 291-1780 Wilmington (877) 889-0001