ClaimsXtenTM Update for Same Day Lab

May 28, 2013

As was published previously, Blue Cross and Blue Shield of New Mexico (BCBSNM) is enhancing the ClaimsXten code auditing tool by adding new rules to the claims processing system, using a phased approach.

Same Day Lab I

Effective April 15, 2013, the Same Day Lab I rule was implemented. This rule identifies claim lines containing a repeat laboratory procedure code that was submitted without modifier 91 and/or when the same laboratory procedure code was previously submitted by the same provider for the same member and for the same date of service. Without a modifier, only one unit of service is allowed.

Same Day Lab II

Effective July 15, 2013, BCBSNM will implement the Same Day Lab II rule, which identifies claim lines containing laboratory procedures that are billed with a line quantity value greater than the range of dates submitted and without either modifier 59 or 91.

For additional information, refer to the ClaimsXten Rule Descriptions listing, available in the Claims and Eligibility/Submitting Claims section of our website.

ClaimsXten is a registered trademark of McKesson Information Solutions, Inc., an independent third party vendor that is solely responsible for its products and services.

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