Coding Resources

  • Coding and billing guidelines

    Find everything you need to know about coding types and sources, special billing situations, and modifiers. View coding and billing guidelines.

    Payment policy news updates

    Get the latest payment policy updates in Provider News.

    Payment policies

    Payment policies are based on industry standard coding and billing guidelines. The policies are maintained by the Premera payment integrity team of certified professional coders. View payment policies.

    Medical policies

    Medical policies address medical necessity criteria based on the highest level of available evidence for evolving technologies, drugs, services, or supplies. Medical policies are maintained by Premera healthcare professionals and certified professional coders. View medical policies.

    The Premera claims editor is located within Availity. Here you can learn more about how the claims editor works.

    Sign in to Availity to access the claims editor.
    Watch a claims editor tutorial.

    First pass editor

    Prepayment claim editing through Lyric-ClaimsXten. This editor enforces correct coding and billing practices as well as evaluate current claims against Premera historical claims for editing purposes using resources such as Premera payment and medical policies:

    • CMS medical coding policies
    • CPT, HCPCS, and ICD-10 coding guidelines
    • Local and regional Medicare policies
    • Nationally recognized academy and society guidelines (coding and clinical)

    Second pass editor

    Prepayment claim editing through Cotiviti to ensure payment accuracy and risk adjustment.

    Coding validation (CV)

    Manual claims editing review by coding experts and certified nurses prior to claims payment.

    Calypso

    Post claims payment review and reprocessing

    Ceris

    Facility claim prepayment review

    Carewise

    Prepayment claims editor

    Appeals process

    Add descriptive sentence here

    View training guides and tip sheets that can support you in caring for your patients and providing accurate coding and documentation.