Nov. 26, 2025
Effective March 1, 2026, we’ll enhance our claims editing process for many commercial members to help ensure accurate coding and proper reimbursement of services.
What’s changing: Following Centers for Medicare & Medicaid Services guidelines effective March 1, 2026, you may not file a claim for two incompatible diagnoses. The correct use of ICD-10-CM codes will be verified. Use of ICD-10-CM clinical modification diagnosis coding guidelines will ensure correct coding and claims processing. Failure to follow the guidelines will result in denied claims for reporting of inappropriate code pairs.
What this means for you: The enhancements require you to continue to follow generally accepted ICD-10-CM coding guidelines. With your help, the enhanced claims review process will help ensure coding and claims processing accuracy. This change should not increase response times.
Inaccurately coded claims will result in denied or delayed payment.
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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.