Atlanta-based Blue Cross and Blue Shield of Georgia has launched the Clear Claim Connection, an online product and service for its network providers. This product, created by McKesson Corp., enables BCBSGa to share with network providers the auditing rules and clinical rationale which exist in the claims billing and auditing code system used by BCBSGa.John Watts, president and chief executive officer of BCBSGa, says, "This important service will enable network physicians and their office staffs to review our payment methodology online. By providing this service, we hope to make our reimbursement policies more readily accessible and reduce misunderstandings among providers, members and BCBSGa."

Blue Cross and Blue Shield of Georgia's Clear Claim Connection is available 24 hours a day, seven days a week on the BCBSGA web site at www.bcbsga.comBy logging on to Provider Access and selecting the Clear Claim Connection option, providers can obtain an immediate response to inquiries; receive clinically based information along with documented source information of the insurer's auditing rules and clinical rationale; and pre-screen a claim or review the rationale for a claim denial.

For procedures and CPT (Current Procedural Terminology) codes requiring review or denial, the system will display the clarification of the edit or denial.

Clear Claim Connection sources include, among others: the American Medical Association Current Procedural Terminology, the CPT Assistant, the CPT Coding Symposium, Specialty Society Coding Guidelines and Medicare Guidelines.

Source: Blue Cross Blue Shield of Georgia

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