New clinical edit goes into effect on December 5

We value the care you provide our members and strive to reimburse you accurately and fairly for that care. Thoughtful implementation of clinical edits supports this goal, while allowing us to process your claims more efficiently.

On December 5, we’ll implement the new clinical edit noted below and outlined in detail in our Recent & upcoming edits for professional claims PDF. Bookmark this link to always have the most updated list.


Telehealth Services: New vs Existing Patients

Claim type: Professional | Product: Commercial

Telehealth services shouldn’t be coded for new patients when the code description is specific to established patients.


Additional information on our clinical edits policy is available online.