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.