As previously communicated, IBC is in the process of transitioning to a new claims processing platform, which will offer greater capabilities, increased flexibility in benefit design, and enhanced functionalities for an improved overall customer experience. As a result of this transition, there will be changes to the enforcement of medical and claim payment policy. IBC's policies will be enforced on both the current and new claims processing platforms; however, some differences in claims processing and outcomes between the two systems may occur depending on when members are migrated, as described in the following. [

]Multiple Surgical Reduction Guidelines[

] For professional providers, the calculation method used in applying Multiple Surgical Reduction Guidelines on the new platform will be based on the procedure reported "Allowed Amount" and not the derived "Surgical Ranking," which is used on the current platform. Please review the Policy Notification for Claim Payment Policy #11.00.10: Multiple Surgical Reduction Guidelines, which will be available on the [Medical Policy portal] after August 2, 2013. This policy, which will become effective November 1, 2013, has been updated to reflect this change and to disclose the different calculations being used within the two claims platforms. [

]Clinical Relationship Logic[

] Clinical Relationship Logic, or Code to Code Edits (e.g., incidental, integral, component, mutually exclusive, etc.), applied to services reported on a CMS-1500 claim form or electronic equivalent may differ depending on whether the claim is processing on the current or new platform. The McKesson ClaimCheck[^®] product will not be used on the new platform. Clinical Relationship Logic, which is based on national standards, will be applied to claims for IBC commercial members processed on the new platform. Once IBC's Medicare Advantage HMO and PPO products are migrated to the new platform, Medicare's NCCI edits will be applied to IBC's Medicare Advantage HMO and PPO products. Clinical Relationship Logic applied to professional claims will be disclosed according to the following: On the current platform. Clinical Relationship Logic applied to professional claims processed on the current platform will continue to be disclosed through IBC's current Clear Claim Connection[^TM] tool, which is available on the NaviNet[^®] web portal or on the []IBC[] website. On the new platform. Clinical Relationship Logic applied to professional claims processed on the new platform will be made available on the IBC []Medical Policy[] website. For the most up-to-date information about our transition to a new claims processing platform, we encourage you to frequently visit our []Business Transformation[] website. At this one central location, we will continue to provide more detailed information as it becomes available about our Business Transformation. [

NaviNet^® is a registered trademark of NaviNet, Inc., an independent company.

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