Oct. 28, 2025
Beginning February 2026, we’ll enhance our claims editing and review process for some of our members with Turquoise Care and Medicare Advantage plans 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.
About the guidelines: We’ll 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.
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