Anthem Blue Cross Blue Shield Health Insurance

Introduction

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Anthem Central uses a proprietary software program licensed from a vendor for the majority of the claims editing in the adjudication of claims. The documents available on this web site are solely Anthem Central customized claims edits and do not include the licensed program edits.  
These customizations are implemented on the FACETS system and may or may not be implemented on other Anthem claims processing systems.  
If you have any questions regarding specific claims adjudication, please contact your provider inquiry representative.  
How to Use the Table of Contents
The Claims Editing website contains a list of edits with links to actual claims edits. The list of claims edits are displayed through the table of contents and are listed under code ranges of 00000 for anesthesia, 10000, 20000, 30000, 40000, 50000, 60000 for surgeries, 70000 for radiology, 80000 for pathology/laboratory, 90000 for medicine, diagnostic testing, physical therapy or occupational therapy, home health procedures/services or home infusion procedures or 99000 for evaluation and management services.  
Each claims edit contains, the subject, the edit number, the rationale and if available the reference for the claims edit.  
A search for locating a specific claims edit may be performed by entering the subject or the code (CPT or HCPCS). The code search may be difficult if the codes on the grid are listed in a range of codes (99201-99499), therefore, knowing the subject may be beneficial.  
This information is for the sole use of our contracted providers and contains confidential and proprietary information. Any unauthorized review, use, disclosure, or distribution is prohibited by the terms of your provider agreement with Anthem Blue Cross and Blue Shield. 
Inclusion of a procedural code or edit in the list below does not imply or guarantee coverage. Furthermore, Reimbursement Policies/Edits evolve over time, and we reserve the right to review and update these Reimbursement Policies/Edits periodically. 
©2005-2013 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use