Claims Editing and Review-AR PASSE-AD-1177
Defines CareSource's automated claims editing and review processes, sources of coding rules, and how providers receive edit outcomes and dispute decisions for Arkansas PASSE providers.
Updated II.B.11 referencing CareSource's website and provider resources during annual review.
Claims Editing Stance and Processes
Claims editing stance and processes
Policy stance on claims editing and the sources that inform automated edits. Covered when ALL of the following apply:
ALL of the following
- CareSource utilizes automated claims editing to enforce appropriate coding and billing practices for all submitted claims.
- All claims submitted to CareSource are subject to automated editing.
- Edits are modeled from industry coding rules, manuals, CMS rules, NCCI, state DHS, professional associations, FDA, CDC, USPSTF, ASC X12, WEDI SNIP, UB Editor, CPT, HCPCS, ICD-10-CM, and CareSource resources (policies, provider manuals, provider notifications).
- CareSource maintains and updates edits as industry changes occur; edits may be added, modified, or removed based on updates from these sources.
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