The Alliance is enhancing our code edits to create more consistency in the application of edits for providers. Since Alliance employers may use a TPA that best meets their needs, Alliance employers use more than 30 different TPAs, where each may apply distinctive claim edits.
The Alliance is continually reviewing new and enhanced edits as published by CMS that become industry standard practice. Claim edits are based on CMS’s NCCI (or CCI) code pair edits and modifier application, which are intended to promote consistent and correct coding and reduce inappropriate reimbursement.
If you would like to learn more about these code edits or if you have any questions please reach out to our provider relations team members.