April 3, 2023
On May 28, we’ll implement the new clinical edits listed below and outlined in detail in the following documents:
Bookmark these links to always have the most updated clinical edit information.
|
Claim type |
Product |
Clinical edit |
|
Professional |
Commercial, individual / ACA, Medicare |
Daratumumab Injection Code on Claim without Approved Indication |
|
Bevacizumab and Biosimilars Billed without Approved Indication |
||
|
Professional and Facility |
All products |
Ocrelizumab Injection Code Billed More Than Twice Per Month |
Additional information on our clinical edits policy is available online.