September 16, 2021
On September 15, 2021, Premera’s virtual provider workshop gave an overview of claims and claims editing.
Here are some highlights:
- Claim editing ensures claims accurately reflect the payable services provided to a member and helps detect and prevent overpayment.
- There are two types of claims editing automated editing and coding validation performed by registered nurses and certified coders.
- Premera’s
claims
editing online tool is a great resource but is not a guarantee of payment or benefit coverage.
- Our medical policies should be used as a guide in evaluating our medical necessity for a particular service or treatment, while payment policies provide Premera’s guidelines for payment on services and claims payment.
If you couldn’t attend the workshop, a recording is available in the Premera Learning
Center. We’re always working on future enhancements to our online provider tools. If you have additional questions or feedback, email providerexperience@premera.com.