Clinical Relationship Logic

Clinical Relationship Logic pertains to the edits used to appropriately adjudicate claims in a claims processing system. As previously communicated, Independence Blue Cross (Independence) completed its transition 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.

Clinical Relationship Logic, or Code-to-Code Edits (e.g., Incidental, Integral, Component, Mutually Exclusive, etc.), is applied to claims submitted on the CMS-1500 claim form or through the 837P transaction.

For more specific information on how the Clinical Relationship Logic is applied, go to the Code-to-Code Edits page.