Payment Integrity Administrative Policy: Coding Validation

EmblemHealth/ConnectiCare has enhanced the existing claim editing program to improve the overall accuracy of claims processing. The policy will be effective on August 30, 2022.

Policy Statement
Edits are designed to detect potential coding errors & incorrect billing practices. New edits address the proper use of modifiers. Modifiers are defined by the AMA and adopted by CMS with a view to providing additional information about the services rendered. The NCCI Policy manual also provides detailed information on modifier usage. 
Coding validation reviews the information so everyone can easily determine whether the modifier has been used correctly. Besides, coding validations edits evaluate the correct use of overriding modifiers.