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Claim Edits

Tuesday, April 30, 2019

The following claim edits are effective for dates of service on or after July 1, 2019. These policies are derived from CMS, the AMA’s Current Procedural Terminology Manual, the Healthcare Common Procedure Coding System, ICD-10, nationally accredited societies and CarePartners of Connecticut policy.

CarePartners of Connecticut will implement the following claim edits:

  • Cardiology
  • Claims processing parameters
  • CMS coverage policies
  • CMS National Coverage Determination (NCD) policies
  • Duplicate services
  • Durable medical equipment
  • Global surgery
  • Laboratory – pathology
  • Neurology

These edits are documented in the applicable CarePartners of Connecticut payment policies available in the Resource Center.