20-912 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.

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

If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:

Line of Business	Telephone Number	Email Address
Cal Mediconnect – Los Angeles County	1-855-464-3571	provider_services@healthnet.com
Cal Mediconnect – San Diego County	1-855-464-3572	provider_services@healthnet.com