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Benefit Information
Claims Coding Resources
Last Updated on January 24, 2019
Providers acknowledge that Security Health Plan may use claim code editing processes for claims adjudication. All Security Health Plan code edits shall be based upon recognized industry standards including but not limited to CCI, CPT, AMA, CMS, or other professional association recommendations.
As a payor, under federal fraud and abuse guidelines, Security Health Plan is restricted from instructing providers on how to bill.
Resources:
Below are a few resources that Security Health Plan suggests as guidance for proper coding:
- Medicare Claims Processing Manual provides diagnosis and procedural coding guidance.
- CMS Policies Medicare Guidelines regarding payment diagnoses for specific services
- The American Academy of Professional Coders: provides education, testing, and professional certification for medical coding
- EncoderPro.com (can be purchased from Optum 360 Coding)
- American Medical Association CPT Manual
- ICD-10_CM Expert (can be purchased from AAPC)
- Medicare Physician Fee Schedule
- Security Health Plan BadgerCare follows Medicaid Guidelines. These are available on the Forward Health website.