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Change in reimbursement display for multiple outpatient surgical procedures

December 2, 2013

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As previously communicated, IBC is transitioning to a new claims processing platform that will offer enhanced functionalities. During this transition, we will be working with you in a dual claims-processing environment until all of our membership is migrated to the new platform. In other words, as members are migrated, their claims will be processed on the new platform; we will continue to process claims on the current IBC platform for members who have not yet been migrated.

One area of change during the transition is to the display of the reimbursement for multiple outpatient surgeries for Indemnity/Traditional, Federal Employee Program (FEP), and Host BlueCard® claims. Please note the following:

  • Claims processed on the current IBC platform. Reimbursement for multiple outpatient surgical procedures will continue to be rolled up and displayed on one payment line, as shown below.
Claim ID Claim line Rev code Procedure code Contracted rate Reimbursement 1234 1 0360 23130 $100 x 2.5 = $250 $375.00 1234 2 0369 23156 $50 x 2.5 = $125 $0.00
  • Claims processed on the new platform. Reimbursement for multiple outpatient surgical procedures will be displayed on two or more separate payment lines, as shown below.
Claim ID Claim line Rev code Procedure code Contracted rate Reimbursement 1234 1 0360 23130 $100 x 2.5 = $250 $250.00 1234 2 0369 23156 $50 x 2.5 = $125 $125.00

As a reminder, as of November 1, 2013, FEP and Host BlueCard claims are processing on the new platform. Indemnity/Traditional claims will continue to be processed on the current IBC platform until this membership is migrated to the new platform.

For more information about our Business Transformation, please visit our dedicated site. On this site, you will find a communication archive and Frequently Asked Questions (FAQ) document. If you still have questions after reviewing the FAQ, email us.

Navinet® is a registered trademark of Navinet, Inc., an independent company.

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