As a reminder, we will update our claim editing software for professional services throughout 2023, with most updates occurring at a minimum quarterly. These updates apply to any provider, provider group (tax identification number) and/or across providers and claim type (professional/facility) and include, but are not limited to:
  • The addition of new, and revised codes (for example, CPT®, HCPCS, ICD-10, modifiers) and associated edits such as:
    • ICD-10 laterality
    • Add-on procedures (indicated by + sign)
    • Code book parenthetical statements and other directives about appropriate code use (for example, separate procedure, do not report, list separately in addition to, etc.)
  • Updates to editing for multiple procedure reduction calculations based on relative value unit (RVU) as designated and updated by the Centers for Medicare & Medicaid (CMS) in the physician fee schedule relative value (PFSRV) files
  • Updates to National Correct Coding Initiative edits (NCCI) and medically unlikely edits (MUEs)
  • Updates to incidental, mutually exclusive, and unbundled (re-bundle) edits
  • Updates to code edits associated with reimbursement policies including, but not limited to, updates to the edits that allow/disallow for assistant surgeon/co-surgeon/team surgeon, frequency edits, bundled services and global surgery preoperative and post-operative periods assigned by CMS


Featured In:
January 2023 Anthem Provider News - Georgia