ClaimsXten is a rules-based software application that edits submitted claims for adherence to Cigna medical coverage and reimbursement policies, benefit plans, and industry-standard coding practices based mainly on CMS and AMA guidelines.

ClaimsXten will facilitate accurate claim processing for medical and behavioral claims submitted on CMS-1500 claim form and for certain claims submitted on a UB-04 claim form. ClaimsXten code editing is based on assumptions about the most common clinical scenarios for services performed by a health care professional for the same patient, while ClaimsXten logic is based upon a thorough review by physicians of current clinical practices, specialty society guidance, and industry-standard coding.

The ClaimsXten code editing rules are detailed in the Code Editing Policy & Guidelines, which can be found at CHCP- Resources - Claim Editing Policies & Procedures (cigna.com).

New code edits and NCCI edits will be applied to CPT and HCPCS codes introduced every January.

• ClaimsXten Frequently Asked Questions