New clinical edits for professional claims go into effect November 26
We value the care you provide our members and strive to reimburse you accurately and fairly for that care. Thoughtful implementation of clinical edits supports this goal, while allowing us to process your claims more efficiently.
On November 26, we’ll implement the new clinical edits listed below and outlined in detail in our Recent & upcoming edits for professional claims PDF. Bookmark this link to always have the most updated list.
| Claim type | Product | Clinical edit |
| Professional | All products |
Pelvic & transvaginal ultrasounds performed concurrently In these cases, the pelvic ultrasound service would be considered inclusive to transvaginal ultrasound. |
|
E/M service bundling E/M services are inherently included in procedures and services performed on the same date, unless the E/M service is considered significant, separately identifiable and supported within the medical record. |
||
|
Oxygen, supplies and accessories rentals reported monthly Reporting more than once per month may be denied. |
||
| Medicare |
DME rentals reported monthly Reporting more than once per month may be denied. |
|
|
Screening studies CPT 76706 should be reported for screening studies only. |
Additional information on our clinical edits policy is available online.