Correct Coding Reminder, CodeReview® Updates

Tufts Health Plan would like to remind you that, as is normal business practice, claims are subject to payment edits that are updated at regular intervals and generally based on Centers for Medicare & Medicaid Services (CMS) guidelines, specialty society guidelines, evaluation of drug manufacturers’ package label inserts, and the National Correct Coding Initiative (NCCI).

Procedure and diagnosis codes undergo annual and quarterly revision by CMS, the American Medical Association, and NCCI. As these revisions are made public, Tufts Health Plan will update its system to reflect these changes during the fourth calendar quarter of 2009.

Payment policies will be updated to reflect the addition and replacement of procedure codes, where applicable.

CodeReview Updates
Tufts Health Plan uses CodeReview®, a claims editing software issued by McKesson, and we are currently in the process of reviewing 2010 CodeReview edit updates.

Beginning in the first calendar quarter of 2010, the most current edits will be applied to claims.

Please continue to use the Clear Claim Connection™ tool on our secure Web site to obtain clinical explanations of how your claim was processed. Clear Claim Connection provides detail that supports CodeReview edits, including bundling denials.

November 1, 2009