New Claim Edits to Support Correct Coding Principles for CMS 1500 submitters

Anthem currently utilizes the McKesson ClaimsXtenTM claim editing solution to administer reimbursement policy and claim edit rules. Anthem will add additional claim edits from Cotiviti Healthcare, another claim editing solution, to further enhance correct coding principles for claims processed on or after December 1, 2016. These additional edits will validate correct coding guidelines as documented in CPT, HCPCS Level II, and ICD- 9 and 10. Also, there will be a greater focus on identifying incorrect or inappropriate duplicative service billing by multiple providers for the same patient on the same day.