Benefit Funds to Upgrade Our Claims Auditing Software

Effective March 1, the Benefit Funds will upgrade our claims-auditing platform, from ClaimCheck to ClaimsXten, to meet our needs for a more comprehensive and well-known solution that is used by many payers to adjudicate applicable claims according to prevailing guidelines. ClaimsXten will assess the appropriateness of professional and outpatient hospital claims information against clinically based coding rules and edits, resulting in accurate and quicker provider reimbursement.

This upgrade to ClaimsXten will:

• Improve the accuracy of the Benefit Funds’ reimbursement coding policies;
• Provide enhanced technical functionality, thus reducing the need for manual reviews; and
• Assist with maintaining a consistent payment policy in alignment with CMS and industry standard billing guidelines.

You will continue to be responsible for billing with the most appropriate and valid CPT and/or HCPCS procedure codes, including applicable modifiers, for services that are consistent with the American Medical Association CPT manual and other similar publications. You will see edit reasons and explanations on your remittance notices when claims are not coded in accordance with the appropriate coding guidelines.

ClaimsXten: Information and Frequently Asked Questions

For more information, visit the Benefit Funds’ website in the coming weeks, contact your Provider Relations Representative or call our Provider Relations Call Center at (646) 473-7160.

More Provider Connections