Provider Workshop: Claims and Claims Editing

  • 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.

     

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