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BLUECONNECT
Providers
September 2023
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
AZ Blue to begin adding secondary code edits in November
Blue Cross® Blue Shield® of Arizona (AZ Blue) is partnering with HealthEdge to implement secondary code edits through the HealthEdge Source® platform. These industry-standard edits will bring greater accuracy to our claim adjudication process and enhance our primary ClaimsXtenTM code edits. We expect the first edits to be implemented sometime in November, with others to follow throughout the rest of this year and in 2024. 
Applicable claims: Medicare Advantage only
To start, we’ll be applying the secondary code edits only to claims for Medicare Advantage (MA) members. This includes both AZ Blue MA members and out-of-area MA members from other Blue Plans. 
Examples of secondary code edits
Here are some examples of the types of secondary code edits we will be implementing:
• Accurate billing of modifiers
• Accurate billing of National Drug Codes (NDCs) and NDC/HCPCS combinations
• Accurate billing of place of service
• Enforcement of additional CMS National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)
We’ll be back in touch with some specific edit examples as we get closer to the implementation time frame. We’ll also be updating the Code Edit Guidelines document, available in the secure provider portal at azblue.com/providers > Provider Resources > Guidelines > Claim Coding > Code Edit Guidelines and C3 Tool > Medical Code Edit Guidelines.
In This Issue
► September news: Executive summary
► Commercial plans transition to MCG care guidelines
► We're streamlining our 2024 HMO product options
► Secondary code edits implementing in November
► Learn + earn credits: Lifestyle medicine and nutrition
Take our Stigma-Free AZ pledge
Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

HealthEdge is a separate, independent company contracted with AZ Blue for claim processing technology. Burgess, a HealthEdge technology company, has developed HealthEdge Source, a single-source claim editing platform.

ClaimsXten is a trademark of Change Healthcare Technologies, LLC, a separate, independent third-party vendor that is solely responsible for its products and services.

© 2023 Blue Cross Blue Shield of Arizona, Inc. All rights reserved.


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