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Clear Claim Connection and Correct Coding Initiative Edits

Blue Cross and Blue Shield of North Carolina (BCBSNC) is increasing itscompliance with industry standards by adopting the Center for Medicare andMedicaid Services (CMS) National Correct Coding Initiative (CCI) into ourpayment policy.

BCBSNC will be enhancing our current claims edits in Clear Claim Connection(C3) and will be including CCI bundling edit logic in all future versions of C3effective 10/1/2011.

The Centers for Medicare and Medicaid Services (CMS) developed correct codingcombination edits based on coding conventions defined in the American MedicalAssociation's CPT manual, national and local policies and edits, codingguidelines developed by national societies, analysis of standard medical andsurgical practices, and a review of current coding practices.

CCI edits are pairs of Current Procedural Terminology (CPT) or HealthcareCommon Procedure Coding System (HCPCS) Level II codes that are not separatelypayable except under certain circumstances. The edits are applied to servicesbilled by the same provider for the same beneficiary on the same date ofservice.

The CCI edits being added to Claim Check review will be the same CCI editsapplied to both commercial business claims and Medicare Advantage (MA) claimsduring the claim check bundling review process. CCI edits are currently appliedto Medicare Advantage (MA) claims during the claim bundling process. Many CCIedits also currently are being applied to BCBSNC commercial business. Thischange enhances the completeness of that editing process, by incorporating allCCI edits into the bundling review. However, claims for commercial business andMA business may not bundle alike, as both BCBSNC commercial business and MAbusiness may apply additional bundling edits outside of those found in ClaimCheck.

Reminder: Please reference the corporate medical policy titled Code Bundling Rules Not Addressed in Claim Check for BCBSNC commercialbusiness claims bundling guidelines and other bundling editing processes thatare not addressed in C3 system.