As a reminder, we are continuing to update our claim editing software for outpatient claims on a monthly basis throughout 2020. These updates will:

  • reflect the addition of new, and revised codes (e.g. CPT, HCPCS, ICD-10, modifiers) and their associated edits
  • include updates to National Correct Coding Initiative (NCCI) edits
  • include updates to incidental, mutually exclusive, and unbundled (rebundle) edits
  • include assistant surgeon eligibility in accordance with the policy
  • include edits associated with reimbursement policies including, but not limited to, frequency edits, medically unlikely edits, bundled services and global surgery preoperative and post-operative periods assigned by The Centers for Medicare & Medicaid Services (CMS)
  • apply to any provider or provider group (tax identification number) and may apply to both institutional and professional claim types including looking across claim types to determine where conflicts may exist between professional (CMS-1500) claims and institutional (CMS-1450) claims.

Featured In:
May 2020 Anthem Blue Cross Provider News - California