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The purpose of this bulletin is to inform providers that DMAS is implementing a new claims software. Effective December 19^th 2022 all claims will be processed via Change Healthcare’s ClaimsXten® software, replacing the current ClaimCheck software. The functionality of the new software remains the same with two new enhancements described below. 

ClaimsXten® Solutions is a flexible claims payment management solution that identifies billing errors before claims are adjudicated.  ClaimsXten® is proprietary, rules-based technology that applies edits and business rules across claims.  The Medicaid National Correct Coding Initiative (NCCI) is still in effect and ClaimsXten® edits will occur after the Medicaid NCCI edits.  DMAS will continue to update Medicaid NCCI edits quarterly as mandated by Centers for Medicare and Medicaid Services (CMS).  Please refer to the previous Medicaid Memorandums, Implementation of ClaimCheck for all Physician and Laboratory Services – Effective January 9, 2006 AND Implementation of the Medicaid National Correct Coding Initiative (NCCI), Procedure to Procedure (PTP), and Medically Unlikely Edits (MUE) – Effective June 3, 2013.  The Memo dates are December 2, 2005 and May 1, 2013 respectively.

Pay Percent Multiple Radiology:   Multiple radiology procedures billed on the same date of service by the same provider will receive a payment reduction.  This applies to all radiology procedures billed as a global service or with modifiers 26 (professional component) or TC (technical component).  Subsequent radiology procedures will reimburse at 50% of the rate if the TC modifier is appended and/or 95% if modifier 26 is appended.

CT modifier:  Use of the CT modifier will cause a reduction in the rate for specific Computed Tomography procedures/services.  This modifier indicates use of equipment that is outdated and does not meet the National Electrical Manufacturers Association (NEMA) standard.  The rate reduction only applies to the technical component and is a 15% reduction of the DMAS allowed amount.

DMAS will continues to use Relative Value Units (RVUs) within the pay percent rules for assistant surgeons, radiology, and multiple procedures when sequencing payment.

Providers that disagree with an action taken by a ClaimsXten® edit may request a reconsideration via email (ClaimCheck@dmas.virginia.gov) or by submitting a request to the following mailing address:

                                         Department of Medical Assistance Services

                                         Payment Processing Unit – ClaimsXten

                                         600 East Broad Street, Suite 1600

                                         Richmond, Virginia 23219