ClaimsXten® — Claims Audit Software

Date Issued: 6/26/2015

In February 2015 EmblemHealth upgraded its ClaimsXten® software to the newer ICD9- and ICD10-compliant version and expanded its use to include GHI claims in April 2015. ClaimsXten® is now used to apply consistent and accurate claim editing and processing guidelines for all GHI, GHI HMO and HIP commercial and government in-and out-of-network medical claims. Prior to this update, only HIP claims were edited by the ICD9-compliant version of this product. EmblemHealth follows the policies of the Centers for Medicare & Medicaid Services, the American Medical Association, and its own medical policy regarding the correct coding of claims.

Edit updates or additions are listed here.