Excellus – Guidance Regarding Clinical Editing Policy Effective August 1

Bulletin issued April 29, 2022, advised that beginning August 1, claims previously recoded in our claims system will no longer recode. These claims will be denied and returned for resubmission with the appropriate CARC and RARC, if applicable. The following example is related to laboratory services and may provide helpful guidance: Laboratory tests 82040, 82247, and 82310 are reported for the same date of service. Laboratory components 82040, 82247, and 82310 will be disallowed because their total exceeds the value of the all-inclusive panel. Panel 80053 is added to the claim. If the sum of the individual values of the components had not exceeded the value of the panel, each individual laboratory test would have been allowed.

Beginning August 1: Laboratory tests 82040, 82247, and 82310 are reported for the same date of service. Laboratory components 82040, 82247, and 82310 will be disallowed because their total value exceeds the value of the all-inclusive panel.

Source: https://provider.excellusbcbs.com/resources/news/article?articleId=9060507&classPK=310638069