AZ Blue to Launch Coding Advisor program - Provider Newsletter December, 2023

Blue Cross^® Blue Shield^® of Arizona (AZ Blue) is partnering with Optum^® for their Coding Advisor services, starting in February 2024. This educational program helps facilitate more accurate coding for certain types of professional services. For example, for evaluation and management (E/M) services, it addresses how to determine which level of CPT^® code appropriately reflects the complexity of the visit. The goal is to increase awareness about industry-standard coding and reduce billing errors that can result in audits and claim processing delays.

How the program works—and what it means for you

The Coding Advisor team will review AZ Blue claim coding data to identify cases where providers are billing significantly differently from other providers in the same specialty (based on the primary taxonomy). The team will then reach out to those providers to share useful data insights and recommend best-practice coding guidance.

You may receive communications and reports from Optum, on our behalf, letting you know how your claim coding activity compares to other providers within your specialty. Please be sure to share these communications with your coding experts to consider how to implement the recommendations.

You may also access Optum’s master-level coders (at no cost to you) for a virtual consultation about your claim coding practices. They can help you ensure that your claim coding and the related medical records accurately represent the services provided.

Value for providers

We trust that you and your billing team will benefit from the educational nature of the Coding Advisor program. The services provided may result in greater accuracy in billing. We look forward to collaborating with you in this way to avoid unnecessary time spent on claim audits, denials, and appeals.

If you have questions about our Coding Advisor program, please contact Optum at 844-592-7009, option 3.

In This Issue

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December news: Executive summary

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5 accepted ways to identify our members

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See our member ID prefix updates for 2024

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New program facilitates accurate coding

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Preview the 2024 Provider Op Guide

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