Feb. 21, 2025
Effective June 1, 2025, we will enhance our claims editing and review process for some oncology drugs and associated services.
This change applies to Medicare Advantage members.
What this means for you: Claims that don’t contain appropriate procedure and diagnosis codes may result in delays or denials.
The enhancements will require you to continue to follow generally accepted claim payment policies. With your help, the enhanced claims review process will help our members get the right care at the right time and in the right setting.
Note: Inaccurately coded claims will result in denied or delayed payment.
About the guidelines: We will continue to follow claim payment policies that are global in scope, simple to understand and come from recognized sources, including:
- ICD-10 coding guidelines
- The Healthcare Common Procedure Coding System
- Current Procedural Terminology (CPT®) codes as documented by the American Medical Association
- Correct Coding Initiatives
- Post-Operative Period Guidelines as outlined by the Centers for Medicare and Medicaid Services
Using these guidelines will help ensure a more accurate review of all claims.
More information: Watch News and Updates for future updates.
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