Jan. 9, 2026
Beginning in January 2026, we’ve enhanced our post pay, claims audit and review process for all our members to help ensure services are properly reimbursed.
What this means for you: The enhancements require you to continue to follow generally accepted claim payment policies.
Inaccurately coded claims will result in recovery requests if overpayment was made.
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 & Medicaid Services
Using these guidelines will help ensure a more accurate review of all claims.
CPT copyright 2025 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
The information provided does not constitute coding or legal advice. Physicians and other health care providers should use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment, and to submit claims using the most appropriate code(s) based upon the medical record documentation, coding guidelines and reference materials.