AdministrativeCommercialJuly 1, 2025

Update: essential ICD‑10‑CM compliance for outpatient facility claims

Effective August 1, 2025, we will update our outpatient facility editing system to align with ICD‑10‑CM correct coding guidelines that require facility claims to include the appropriate primary diagnosis for outpatient services. Ensure that Box 67 on the UB‑04 claim form contains the correct principal diagnosis so that your claims process successfully.

Refer to the ICD‑10‑CM Official Guidelines for more information. If you have concerns about the outcome of a claim, you are encouraged to use the standard claim dispute process outlined in the provider manual to address them.

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-083486-25, CPN83055

PUBLICATIONS: July 2025 Provider Newsletter