From Priority Health:
As posted on our website as a recent news item earlier this month and in Clinical Edits Listing webpage, we’ve defined each edit and outlined the coding procedures that will help ensure payment.
Ensuring your patients, our members, receive the right care at the right price is central to our partnership with you and all providers in our network. Clinical edits help us achieve this goal by identifying coding errors, non-standard utilization patterns and more.
On Sept. 15, 2022, the clinical edits outlined below will go into effect:
|
Claim type |
Product |
Clinical edit |
|
Facility claims |
All products |
Device-Intensive Procedures Requiring Device HCPCS Code |
|
Revenue Code Requires HCPCS |
||
|
Resubmissions for Adjusted Claim Type of Bills and Change Reason Codes |
||
|
Multiple Facility E/M Services on the Same Date |
We adopted these edits based on Center for Medicare and Medicaid Services (CMS) guidelines.
How to ensure payment
In our recent news item and in Clinical Edits Listing webpage, we’ve defined each edit and outlined the coding procedures that will help ensure payment