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Clinical payment, coding and policy changes


We regularly adjust our clinical payment and coding policy positions as part of our ongoing review processes. Our standard payment policies identify services that may be incidental to other services and, therefore, ineligible for payment. In developing our policies, we may consult with external professional organizations, medical societies and the independent Physician Advisory Board, which advises us on issues of importance to physicians. The following will change effective June 1, 2019:

 

  

  • Our claims editing capability. We’ve recently expanded our claims editing capability by adding new third-party claims edits. We’ll be adding more on June 1. To view these edits, check our provider website for information. There, you’ll have access to our prospective claims editing disclosure tool. After you log in, go to Plan Central > Aetna Claims Policy Information > Policy Information > Expanded Claims to find out if our new claims edits will apply to your claim. This is subject to regulatory review and separate notification in Washington state. 

 

  •  Billable time units. We’ll limit billable time units for unlisted or NOS (not otherwise specified) CPT® and HCPCS codes to once per day.