As a reminder, we will upgrade our claim editing software for professional services monthly throughout 2022, with most updates occurring quarterly. These upgrades may apply to same provider, provider group (tax identification number). They may also apply across providers and across claim types (professional/facility) and include, but are not limited to:

  • addition of new, and revised codes (e.g. CPT, HCPCS, ICD-10, modifiers) and their associated edits such as:
    • ICD-10 laterality and Excludes1 notes
    • Add-on procedures (indicated by + sign)
    • Code book parenthetical statements and other directives about appropriate code use (e.g. “separate procedure”, “do not report”, “list separately in addition to”, etc...)
  • updates to National Correct Coding Initiative edits (NCCI) and medically unlikely edits (MUEs)
  • updates to incidental, mutually exclusive, and unbundled (rebundle) edits
  • updates to assistant and co-surgeon eligibility in accordance with the policy
  • updates to edits associated with reimbursement policies including, but not limited to, frequency edits, bundled services and global surgery preoperative and post-operative periods assigned by The Centers for Medicare & Medicaid Services (CMS)



Featured In:
December 2021 Anthem Connecticut Provider News