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    • We’ve enhanced our claims editing process

     

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

     

    If the coding edit doesn’t apply to the services performed, you have a right to request a reconsideration/appeal. Just include supporting information, such as the medical records, along with the reason you find the edit doesn’t apply.

     

    When it’s appropriate, we evaluate claims against:
     

    • 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
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