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 UB04 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