Prescreen claims

Use the Clear Claim Connection (C3) simulation tool to test HCPCS/CPT codes and view clinical edits with rationales.

Payment processing codes

Refer to the following documents for Blue Shield's payment processing logic and procedure codes:

Blue Shield Payment Processing Logic (PDF, 18 KB)

Hospital Acquired Condition (HAC)/Never Events Codes (Excel, 345 KB)  Effective 10/01/2021 - 09/30/2022

Incidental Procedure Codes (PDF, 73 KB)

Office-Based Ambulatory Procedure Codes (PDF, 90 KB)

Local Code/National Code Crosswalk (PDF, 146 KB)

Payment policies