New clinical edit goes into effect Oct. 15, 2022
Ensuring your patients, our members, receive the right care at the right price is central to our partnership with you and all providers in our network. To help us achieve this goal, we’ll implement a new clinical edit – “Diagnosis Coding, Excludes1” – on October 15.
Coding to the highest level of specificity
This edit stems from ICD-10 coding guidelines, which require coding to the highest level of specificity. Their Excludes1 criteria details diagnosis codes that shouldn’t be reported together because the two codes can’t occur at the same time.
Resubmitting denied claims
You’ll be able to resubmit denied claims with corrected diagnosis codes to receive payment.
Get more information
Reference the ICD-10 coding manual’s Excludes Notes section for more detail and examples.
Clinical Edits Listing
See new and upcoming clinical edits, organized by provider type and line of business.