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We’ve enhanced our claims editing process

 


Our claim system edits complex claim scenarios to make sure coding and modifier usage aligns with industry guidelines. For example, we evaluate appropriate utilization of separate and distinct service modifiers as well as the separately identifiable evaluation and management modifiers.

 

When appropriate, we evaluate claims against the following guidelines:

 

  • Internal coding guidelines
  • The Centers for Medicare & Medicaid Services medical coverage, payment and coding policies
  • The American Medical Association Current Procedural Terminology® (CPT®) coding standards