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New Clinical Editing Policy Effective April 1, 2022

Audience: All Professional Providers

Univera Healthcare is implementing a clinical editing policy effective April 1, 2022, which will no longer provide reimbursement for codes that have a Centers for Medicare and Medicaid Services (CMS) status indicator. The policy, which is in line with CMS rules, only applies to Medicare Advantage business. 

The Health Plan uses the Medicare Physician Fee Schedule to apply the status indicator rules, per CMS guidelines. Access the fee schedule at cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Relative-Value-Files.html.

Thank you for the service that you provide to our valued members. If you have questions, please contact your Provider Relations representative.
 

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