Sept. 6, 2023

Using correct coding is critical to ensure we apply benefits and reimbursement correctly to claims. We encourage our providers to strive for highest level of detail in the coding they use. This applies to all coding submitted on a claim for payment. Using coding that is “unspecified” or “unknown” could cause denials or delays in reimbursement.

At the time of service, you may not have specific codes. However, it is best to determine what the condition is or what exactly is being treated before coding and submitting the claim.

Benefits of using specific codes include:

• Accurate reimbursement.
• Reduced number of corrected claims.
• Quicker processing of claims.
• Lower number of denials.

To ensure claims follow the correct coding guidelines, we encourage you to:

• Consult with your business partners who code and bill on your behalf to ensure they use proper coding.
• Ensure all appropriate staff are current on correct coding guidelines.
• Review your remittances, locate impacted claims and make the necessary changes.

If you have any questions on this bulletin, please contact Provider Education at Provider.Education@bcbssc.com or 803-264-4730.