We'll continue to update clinical edits to comply with current coding guidelines

Blue Care Network continues to review and modify clinical edits. With these updates, you may notice that claims may receive different edits than they have in the past. And others that previously received edits may not receive any. We take pride in staying up-to-date on current coding standards and national coding guidelines in addition to recommendations from professional societies.

You may notice new edits related to those that review procedure codes to the reported diagnoses. Diagnosis codes should be coded appropriately and to the highest level of specificity to support the service performed. If you do not agree with the clinical edit, please follow our clinical editing appeal process.

Visit bcbsm.com/providers.

• Log in to Provider Secured Services.
• Click BCN Provider Publications and Resources on the right.
• Click Billing/Claims in the left navigation.
• Click Appealing a BCN clinical editing denial, under the Clinical Editing Resources heading.

Posted: June 2019
Line of business: Blue Care Network