System updates for 2020: Professional

As a reminder, we will update our claim editing software monthly throughout 2020 with the most common updates occurring in quarterly in February, May, August and November of 2020. These updates will:

 

• Reflect the addition of new, and revised codes (such as 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