20-911 Stay in Compliance with National and ICD-10 Coding Guidelines

Date: 11/16/20

This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, and Ancillary providers.

This information applies to Medi-Cal in Fresno, Kings and Madera counties.

Corrected coding does not modify or rescind an authorization for services

All claims submitted for payment are subject to editing to ensure the claim complies with National Correct Coding Guidelines and the ICD-10-CM Official Guidelines for Coding and Reporting. If your claim is denied, you will need to resubmit a corrected claim following the National and ICD-10 coding guidelines.

These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM:

• The American Hospital Association (AHA)
• The American Health Information Management Association (AHIMA)
• Centers for Medicare & Medicaid Services (CMS)
• National Center for Health Statistics (NCHS)

Editing for correct coding

Editing for correct coding does not in any way modify or rescind an authorization for services, nor does this have any impact on the medical necessity determination of that service.

Additional Information

Providers are encouraged to access the provider portal online at provider.healthnet.com for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact
CalViva Health at 1-888-893-1569.