New Phase Added to ClaimsXten

By March 9, 2026: (1) Billing team must conduct comprehensive audit of all outpatient consultation claims to ensure compliance with Phase 3 consultation coding guidelines; (2) Update billing system validation rules to flag duplicate claim submissions from facilities and prevent resubmission of identical claims on the same date of service; (3) Review all claims for unbundled code pairs and update system edits to identify when Column Two codes are submitted with Column One codes without appropriate NCCI-associated modifiers; (4) Clinical staff and providers must be trained on Phase 3 changes, including NCCI procedure-to-procedure (PTP) edits, medically unlikely edits (MUEs), and add-on code requirements; (5) Establish internal compliance checklist for outpatient consultations, duplicate submission prevention, and proper code pairing before claim submission. Failure to implement these changes will result in automated claim denials, increased manual review, payment delays, and potential compliance issues with BlueCross BlueShield of South Carolina and BlueChoice HealthPlan.