Code Editing Policy and Guidelines - For Providers November 2020, Last updated September 29, 2020 Cigna is in alignment with the edits outlined by ...
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Code Editing Policy and Guidelines
For Providers
November 2020, Last updated September 29, 2020
Cigna is in alignment with the edits outlined by CMS with the exception of the
removals CMS instituted during the COVID-19 crisis. Cigna will continue to apply
the edits initially instituted by CMS.
Current Procedural Terminology (CPT®) codes, Health Care Procedure Coding System (HCPCS) codes,
and modifiers are used to represent services provided and procedures performed. Correct coding, including
appending modifiers appropriately, enables accurate identification of the submitted service or procedure
and leads to more efficient claim processing. The guidelines in this document are not all-inclusive.
ClaimsXten
We use ClaimsXten™, a clinical code editing software also developed by Change Healthcare, for medical
and behavioral products. ClaimsXten facilitates accurate claim processing for medical and behavioral
claims submitted on the Centers for Medicare and Medicaid Services (CMS) 1500 claim form and for certain
claims submitted on a UB04 claim form. ClaimsXten code auditing is based on assumptions about the most
common clinical scenarios for services performed by a provider for the same patient. ClaimsXten logic is
based on a thorough review by doctors of current clinical practices, specialty society guidance, and industry-
standard coding.
ClaimsXten is the software we use to administer some of our reimbursement, medical, and administrative
policies, as well as some benefit plan provisions. In some situations, Cigna's reimbursement or medical
policy may differ from industry-standard coding, such as a CMS sourced code edit. When that happens,
Cigna's posted policy will supersede the industry-standard edit.
Clear Claim Connection™, Cigna's code edit disclosure tool powered by Change Healthcare, allows users
to enter CPT and HCPCS coding scenarios and to immediately view the audit result. Clinical edit rationales,
as well as edit sourcing, are provided for any code disallowed in Clear Claim Connection.
New code edits and National Correct Coding Initiative (NCCI) edits are applied to CPT and HCPCS codes
introduced every January.
Updates to coding guidelines and NCCI edits will be applied quarterly for ClaimsXten code editing software.
On February 15, 2020, ClaimsXten was updated to First Quarter Knowledge Base content and NCCI
Version 26.0 for all medical and behavioral claims we process.
On May 16, 2020, ClaimsXten was updated to Second Quarter Knowledge Base content and NCCI
Version 26.1 for all medical and behavioral claims we process.
On August 16, 2020, ClaimsXten was updated to Third Quarter Knowledge Base content and NCCI
Version 26.2 for all medical and behavioral claims we process.
On November 15, 2020, ClaimsXten will be updated to Fourth Quarter Knowledge Base content and
NCCI Version 26.3 for all medical and behavioral claims we process.
1Code Edits
Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Add-On Code Add-on codes are CPT and HCPCS-defined codes that are to be billed in CMS 1500
Without Base addition to a base code during a session. An add-on code cannot be billed
Code and Add- as a standalone code. The American Medical Association (AMA) has
On Code assigned specific base codes for most add-on codes.
Without Base
Code 2 The Add-On Without Base Code Rule recommends the denial of claim
lines containing an add-on code where there is an AMA-defined base
code that has not also been reported for the same customer and provider
on the same date of service.
The Add-On Without Base Code 2 Rule recommends the denial of claim
lines containing an add-on code where a base code has not also been
reported for the same customer and provider on the same date of service.
The add-on codes contained in this rule do not have specific base codes
defined for them in CPT or HCPCS. The add-on code has been
associated with the specific CPT or HCPCS category of services to which
the base code would belong.
Anesthesia In alignment with AMA/CPT coding guidelines, anesthesia providers bill CMS 1500
Crosswalk for anesthesia services by reporting the CPT code for anesthesia
administration, and not the CPT code representing the surgical services.
The American Society of Anesthesiologists (ASA) Crosswalk Table
converts CPT procedure codes to anesthesia codes as appropriate when
a claim for anesthesia services, as identified by provider type, specialty, or
identification number, is submitted with a code other than a designated
anesthesia code.
The ASA Anesthesia Standard Crosswalk Rule identifies procedure codes
for non-anesthesia services submitted by an anesthesiology provider that
have a one-to-one relationship with anesthesia services as identified by
the ASA. The rule will replace that procedure with the appropriate
anesthesia procedure code as specified in the ASA Crosswalk Table, and
the cross-walked code will be considered for payment.
Anesthesia Many non-anesthesia CPT codes often describe procedures that may be CMS 1500
Crosswalk 2 done in a variety of anatomic regions, while anesthesia CPT codes are
specific to both procedure and region.
The ASA Anesthesia Multiple Crosswalk Rule will identify claim lines
submitted by an Anesthesiology Provider, with a non-anesthesia CPT
code that has a one-to-many relationship with an anesthesia code.
2Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Anesthesia Not The ASA Crosswalk Table converts CPT procedure codes to anesthesia CMS 1500
Eligible codes as appropriate when a claim for anesthesia services, as identified
by provider type, specialty, or identification number, is submitted with a
code other than a designated anesthesia code.
The ASA Anesthesia Not Eligible Rule will disallow claim lines submitted
by anesthesia providers for non-anesthesia procedure codes that are not
eligible to be cross-walked to an anesthesia procedure code.
According to the ASA, certain codes cannot be cross-walked for one of
the following reasons: it is not a primary procedure code, anesthesia care
is not normally required, it is a radiology service related to a diagnostic or
therapeutic service, or it is a non-specific unlisted procedure code.
Assistant This rule identifies claim lines containing procedure codes submitted with CMS 1500
Surgeons and the Assistant Surgeon (modifiers 80, 81, 82) and Assistant-at-Surgery
Assistants-at- (modifier AS) designations where there is a payment restriction for
Surgery Assistant Surgeon/Assistant-at-Surgery according to the CMS Medicare
Physician Fee Schedule.
CMS Assistant Surgeon/Assistant-at-Surgery designations of “2” are
allowed without documentation.
Please note: CMS Assistant Surgeon/Assistant-at- Surgery designations
of “0” require supporting documentation with the initial claim submission.
For more details, please see Assistant Surgeon – Modifiers 80, 81, 82,
Assistant-at-Surgery – Modifier AS, Co-Surgeon (Two Surgeons) –
Modifier 62, Surgical Team – Modifier 66 Reimbursement Policy, MAS, on
the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies and
Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
Base Code Certain CPT procedure codes are used to report a primary CMS 1500
Quantity service/procedure, or base code, which are only appropriately billed once
per date of service. CPT provides add-on codes to report additional
services associated with the primary or base procedure.
When billing a base code procedure, additional services beyond the
primary service/procedure should be billed with an appropriate add-on
code. Quantities of base code greater than one will be disallowed and
replaced with a new line with the same procedure code and quantity equal
to one.
Bundled Certain procedure codes are designated by CMS as “bundled” by a status CMS 1500
Service code indicator of “B” on the CMS National Physician Fee Schedule
Relative Value File. When billed with any other procedure code that is not
indicated as a “bundled” service, these procedures are considered a
component of, or incident to, the overall service provided, and separate
reimbursement is not warranted.
3Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Component The CMS National Physician Fee Schedule Relative Value file directs that CMS 1500
Billed a global procedure includes reimbursement for both the professional and
technical components of certain procedures.
If a professional or technical component of a procedure is submitted and
the same global procedure was previously submitted by the same
provider ID for the same customer for the same date of service, the
component service will not be additionally reimbursed.
Co-Surgeon This rule identifies claim lines containing procedure codes submitted with CMS 1500
Modifier 62 the Co-Surgery modifier –62 where there is a payment restriction for Co-
Surgery according to the CMS Medicare Physician Fee Schedule.
Please note: CMS Co-Surgeon designations of “1” require supporting
documentation with the initial claim submission.
For more details, please see Assistant Surgeon – Modifiers 80, 81, 82,
Assistant-at-Surgery – Modifier AS, Co-Surgeon (Two Surgeons) –
Modifier 62, Surgical Team – Modifier 66 Reimbursement Policy, MAS, on
the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies and
Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
Deleted Code This rule recommends the denial of claim lines containing deleted CMS 1500
procedure codes when submitted after the deletion date of the procedure
code. The provider is required to submit a corrected claim with the code
that is valid for the date of service.
Frequency Many procedures are limited to a specified number of times they may be CMS 1500
Edits performed per date of service. Change Healthcare Frequency Edits are UB04
developed based on the CPT/HCPCS code description, anatomic
considerations, CPT instructions, CMS policies, nature of service or
procedure, nature of analyte, nature of equipment, and clinical judgment
or clinical feasibility. Frequency edits disallow procedures exceeding the
maximum number of times they may be performed per date of service.
In most instances, we are aligned with CMS Medically Unlikely Edits
(MUEs) for frequency limitations.
When CMS has no frequency designation for a procedure or service, we
default to Change Healthcare frequency edits for that procedure or item.
This rule may also apply to frequency criteria identified within medical
coverage policies and/or reimbursement policies.
4Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Global Reimbursement for certain services is based on preoperative and CMS 1500
Allowance postoperative global allowance established by the CMS. Claims for
services considered directly related to a procedure’s global allowance are
considered integral to that service and will not be separately reimbursed.
Minor surgical procedures have either a zero- or 10-day postoperative
global period. Major surgical procedures have a one-day preoperative and
90-day postoperative period for medical visits. Follow-up office visits
during the post-operative period are included in the procedure’s global
allowance and will not be separately reimbursed.
Please note: Submit the CPT/HCPCS code only once and without a
modifier to report the global value of the service. A frequency edit will
occur on many codes if they are reported more than once for the same
date of service.
Global The CMS National Physician Fee Schedule Relative Value file directs that CMS 1500
Component a global procedure includes reimbursement for both the professional and
technical components of certain procedures. A single provider can bill for
both components (global procedure), or different providers can each bill
for different components. Claims for these types of procedures are paid
up to the total of the global procedure (both technical and professional
components combined). Any submission of the same procedure will be
evaluated against previous submissions to determine if any or all
components of the procedure have already been paid and the claim will
be adjusted accordingly.
If a global procedure is billed on a current line or support line without
modifier –26 or –TC present in any modifier fields, and the claim facility
flag = Y, the technical component (–TC) will be assumed.
If a global procedure is billed on the current line without modifier –26 or
–TC present in any modifier fields, and the claim facility flag = N, and the
Place of Service (POS) is inpatient or outpatient, the professional
component (–26) will be assumed on the current line.
Please note: If either –TC or –26 have been paid in history, and a global
procedure is reported (either a current claim line reported with both
modifiers –TC and –26, or a claim line reported without any modifiers but
with a facility flag of N and a POS not inpatient or outpatient) on the
current claim line, the global component will be denied. A claim line will be
added with the appropriate component to prevent overpayment.
5Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Global As defined by AMA/CPT coding guidelines, the total obstetric package CMS 1500
Obstetric Care includes antepartum care, the admission to the hospital, the admission
history and physical examination, management of uncomplicated labor,
vaginal delivery (with or without episiotomy, with or without forceps), or
cesarean delivery, and postpartum care.
This rule evaluates claim lines to determine if any global obstetric care
codes were submitted with another global obstetric care code or a
component code such as the antepartum care, postpartum care, or
delivery only services, during the average length of time of the typical
pregnancy and postpartum period as applicable.
For more details, please see Global Maternity/Obstetric Package
Reimbursement Policy, R11, on the secure Cigna for Health Care
Professionals website (CignaforHCP.com > Resources > Clinical
Reimbursement Policies and Payment Policies > Modifiers and
Reimbursement Policies > Reimbursement Policies).
Incidental A procedure that is performed at the same time as a more complex CMS 1500
Procedure primary procedure, requiring little additional physician resources and/or is
Edits clinically integral to the performance of the primary procedure, is
considered incidental to the related primary procedure(s) on the same
date of service and will not be separately reimbursed.
Inpatient A consultation is a type of service provided by a physician at the request CMS 1500
Consultations of another physician or appropriate source to either recommend care for a
specific condition or problem, or to determine whether to accept
responsibility for ongoing management of the patient’s entire care or for
the care of a specific condition or problem. Furthermore, [If] subsequent to
the completion of the consultation, the consultant assumes responsibility
for the management of a portion or all of the patient’s condition[s], the
appropriate Evaluation and Management (E&M) service code for the site
of service should be reported.
For more details, please see Evaluation and Management Services
Reimbursement Policy, R30, on the secure Cigna for Health Care
Professionals website (CignaforHCP.com > Resources > Clinical
Reimbursement Policies and Payment Policies > Modifiers and
Reimbursement Policies > Reimbursement Policies).
Medical The medical policy rule applies editing based on criteria found in Cigna's CMS 1500
Policy applicable medical coverage or reimbursement policies. UB04
An example of such an edit would be procedure to diagnosis. Denial of
claim lines would occur if a covered diagnosis is not reported on the claim
in conjunction with the corresponding procedure. For additional
information about our medical coverage or reimbursement policies, please
visit our Cigna for Health Care Professionals website at CignaforHCP.com
> Resources > Clinical Reimbursement Policies and Payment Policies.
6Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Medically The Medically Unlikely Edit (MUE) Rule applies frequency limitations as CMS 1500
Unlikely Edit defined by CMS and adopted by Cigna. These edits were developed by
(MUE) CMS based on a number of considerations including anatomic
considerations, HCPCS/CPT code descriptors, CPT instructions, nature of
service/procedure, nature of equipment, and clinical judgment. This rule
will disallow payment for non-facility claim services exceeding the MUE
value for a CPT/HCPCS code across all claim lines by the same provider,
for the same customer, on the same date of service.
Cigna is not in alignment with CMS regarding the MUE limits for many
codes.
For more details, please see Frequency Editing Reimbursement Policy,
R34, on the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies and
Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
The CMS MUE of 2 for codes 99212, 99213 and 99214 is excluded from
editing as it conflicts with Cigna’s reimbursement policy indicating that we
only pay 1 E&M service per provider per single date of service.
For more details, please see Modifier 25 Reimbursement Policy, M25, on
the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies and
Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
Missing This rule has 2 components. This rule recommends the denial of claim CMS 1500
Modifier 26 lines containing a procedure code submitted without a professional
component modifier -26 in a facility setting. The rule replaces the line with
a new line with the same procedure code and the professional component
modifier –26.
This rule also recommends the denial of claim lines containing a
procedure code submitted with a technical component modifier –TC but
without a professional component modifier –26 in a facility setting. The
rule would deny the claim line.
Modifier to Modifiers provide a way to indicate that a service or procedure that has CMS 1500
Procedure been performed has been altered by a specific circumstance. Certain
Validation procedures can be reported with a modifier that allows payment for
services otherwise bundled, due to additional significant, separately
identifiable services. Separate reimbursement will not be allowed for
services reported with specific “payment-affecting” modifiers if the modifier
is not appropriate for the procedure code billed. When multiple modifiers
are submitted on a line, all are evaluated and if at least one is found
invalid with the procedure code, the line will be recommended for denial.
7Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Mutually Mutually exclusive procedures are two or more procedures that are not CMS 1500
Exclusive usually performed during the same patient encounter on the same date of
Procedure service. Generally, an open procedure and a closed procedure in the
Edits same anatomic site will not be separately reimbursed. If both procedures
achieve the same result, only one will be reimbursed; most often the more
clinically intense procedure.
National The CMS established the National Correct Coding Initiative (NCCI) CMS 1500
Correct Coding program to ensure the correct coding of services. The NCCI edits are also UB04
Initiative known as column 1/column 2 or procedure to procedure (PTP) edits. In
(NCCI) most instances, Cigna follows CMS sourced code edits. But when CMS is
Column not the most appropriate source, Cigna applies other accepted industry
One/Column standard edits based upon guidance from AMA, specialty society
Two Edits guidance or similar sources.
NCCI PTP edits prevent inappropriate payment of services that should not
be reported together. Each edit has a column 1 and column 2
HCPCS/CPT code and a Correct Coding Modifier Indicator.
If a provider reports the two codes of an edit pair for the same beneficiary
on the same date of service and the Modifier Indicator is 0, the column 2
code is denied, and the column 1 code is eligible for payment.
If the Modifier Indicator is 1 and an NCCI-associated modifier is used
because the appropriate clinical circumstances are met, the NCCI edit will
be bypassed and the column 2 code will be considered for payment. If the
Modifier Indicator is 1 and an NCCI-associated modifier is not used, the
column 2 code is denied.
This rule also applies to facility claims consistent with the National Correct
Coding Initiatives (NCCI) edits and guidelines as outlined by the Centers
for Medicare and Medicaid Services (CMS). For more details, please see
National Correct Coding Initiatives (NCCI) Editing for Facilities
Reimbursement Policy, R09, on the secure Cigna for Health Care
Professionals website (CignaforHCP.com > Resources > Clinical
Reimbursement Policies and Payment Policies > Modifiers and
Reimbursement Policies > Reimbursement Policies).
Never Events We will not reimburse services identified as avoidable or should never CMS 1500
and Avoidable occur, consistent with our reimbursement policy for Never Events and
Hospital Avoidable Hospital Conditions.
Conditions
For more details, please see Never Events Reimbursement Policy, R05,
on the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies and
Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
New Patient This rule recommends the denial of claim lines containing a new patient CMS 1500
Evaluation & E&M code when another claim line containing any E&M code was billed
Management by the same provider within a three-year period. The new patient code will
(E&M) Code be replaced with the appropriate established patient code.
8Code Applicable
Editing Claim
Definition and Information
(ClaimsXten) Form
and/or Rule
Outpatient A consultation is a type of service provided by a physician at the request CMS 1500
Consultations of another physician or appropriate source to either recommend care for a
specific condition or problem or to determine whether to accept
responsibility for ongoing management of the patient’s entire care or for
the care of a specific condition or problem. Furthermore, [If] subsequent to
the completion of the consultation, the consultant assumes responsibility
for the management of a portion or all of the patient’s condition[s], the
appropriate E&M service code for the site of service should be reported.
For more details, please see Evaluation and Management Services
Reimbursement Policy, R30, on the secure Cigna for Health Care
Professionals website (CignaforHCP.com>Useful Links>Policies and
Procedures>Modifiers and Reimbursement Policies).
Rebundling Procedure unbundling occurs when two or more procedure codes are CMS 1500
Procedure used to report a service when a single, more comprehensive procedure
Edits code is available. ClaimsXten rebundles the single procedure codes to
the comprehensive CPT/HCPCS code. ClaimsXten will add the
comprehensive code if a procedure code that more accurately
represents the service exists but is not included on the claim.
The CMS designates certain procedures to be “always bundled into
payment for other services not specified.” These procedures have a
status code indicator of “B” on the CMS National Physician Fee
Schedule Relative Value File. These procedures are edited by the
ClaimsXten Bundled Service Rule.
T-Status This rule identifies claim lines containing T status procedure codes that CMS 1500
Codes are not payable when billed on the same date of service as any
procedure payable under the physician fee schedule (defined as status
A and R codes) for the same customer and same provider.
Team CMS 1500
Surgeon This rule identifies claim lines containing procedure codes submitted
Modifier 66 with the Team Surgery modifier –66 where there is a payment
restriction for Team Surgery according to the CMS Medicare Physician
Fee Schedule.
Please note: CMS Team Surgeon designations of “1” require
supporting documentation with the initial claim submission.
For more details, please see Assistant Surgeon – Modifiers 80, 81, 82,
Assistant-at-Surgery – Modifier AS, Co-Surgeon (Two Surgeons) –
Modifier 62, Surgical Team – Modifier 66 Reimbursement Policy, MAS,
on the secure Cigna for Health Care Professionals website
(CignaforHCP.com > Resources > Clinical Reimbursement Policies
and Payment Policies > Modifiers and Reimbursement Policies >
Reimbursement Policies).
9Policy History Updates
Date Change/Update
September 29, 2020 Added reference to R34 Frequency Editing Reimbursement Policy.
July 28, 2020 Notification of 4Q2020 Knowledge Pack and NCCI edit update.
May 5, 2020 Notification of 3Q2020 Knowledge Pack and NCCI edit update.
May 1, 2020 Cigna is in alignment with the edits outlined by CMS with the exception of the removals CMS instituted during
the COVID-19 crisis. Cigna will continue to apply the edits initially instituted by CMS. Frequency Edits and
National Correct Coding Initiative (NCCI) Column One/Column Two Edits sections updated to state in most
instances, we are aligned with CMS. HCPCS Modifier Updates language effective August 2014 removed.
Anesthesia Crosswalk 2 documentation handling information removed. Minor wording and/or routing revisions
made to: Assistant Surgeons and Assistants-at-Surgery; Co-Surgeon Modifier 62; Frequency Edits; Global
Obstetric Care; Medically Unlikely Edit (MUE); Missing Modifier 26; Modifier to Procedure Validation; National
Correct Coding Initiative (NCCI) Column One/Column Two Edits; Never Events and Avoidable Hospital
Conditions; and, Team Surgeon Modifier 66 sections. Inpatient and outpatient consultation information replaced
with reference to Evaluation and Management Services Reimbursement Policy, R30, in the Inpatients
Consultation and Outpatient Consultations sections. Medical Coverage Policy section renamed to Medical
Policy; routing information updated.
January 29, 2020 Notification of 2Q2020 Knowledge Pack and NCCI edit update.
October 30, 2019 Notification of 1Q2020 Knowledge Pack and NCCI edit update.
July 9, 2019 Notification of 4Q2019 Knowledge Pack and NCCI edit update.
April 23, 2019 Notification of 3Q2019 Knowledge Pack and NCCI edit update.
January 23, 2019 Notification of 2Q2019 Knowledge Pack and NCCI edit update.
October 23, 2018 Notification of 1Q2019 Knowledge Pack and NCCI edit update.
August 10, 2018 Notification of 4Q2018 Knowledge Pack and NCCI edit update.
May 1, 2018 Notification of 3Q2018 Knowledge Pack and NCCI edit update.
January 31, 2018 Notification of 2Q2018 Knowledge Pack and NCCI edit update.
November 17, 2017 Notification of 1Q2018 Knowledge Pack and NCCI edit update.
August 7, 2017 Notification of 4Q2017 Knowledge Pack and NCCI edit update. Added Global Obstetric Care edit information.
July 31, 2017 References to McKesson updated to Change Healthcare
May 21, 2017 Notification of 3Q2017 Knowledge Pack and NCCI edit update. Updated “health care professional” to “provider”
where appropriate.
April 11, 2017 National Correct Coding Initiative (NCCI) Column One/Column Two Edits section updated to include Cigna's
application of other accepted industry standard edits based upon guidance from AMA, specialty society
guidance or similar sources when CMS is not the most appropriate source.
February 17, 2017 Notification of 2Q2017 Knowledge Pack and NCCI edit update.
October 24, 2016 Notification of 1Q2017 Knowledge Pack and NCCI edit update.
July 25, 2016 Minor wording changes made to comply with Words We Use direction. Notification of 4Q2016 Knowledge Pack
and NCCI edit update.
August 13, 2016 Notification of 3Q2016 Knowledge Pack and NCCI edit update.
May 14, 2016 Notification of 2Q2016 Knowledge Pack and NCCI edit update.
February 13, 2016 Notification of 1Q2016 Knowledge Pack and NCCI edit update. Added POS 19 to Missing Modifier 26 Code
November 7, 2015 Edit.
Notification of 4Q2015 Knowledge Pack and NCCI edit update. Language added noting some reimbursement,
medical policies and some benefit plan provisions administered in ClaimsXten. Language added noting some
UB04 claims processed through ClaimsXten.
August 15, 2015 Notification of 3Q2015 Knowledge Pack and NCCI edit update.
July 13, 2015 Update to Medically Unlikely Edit (MUE) rule for 99212-99214 exception.
June 6, 2015 Notification of 2Q2015 Knowledge Pack and NCCI edit update.
March 6, 2015 Added clarifying policy and Clear Claim Connection wording.
February 16, 2015 Moved Reimbursement Policies to the Omnibus Policy R24. Revised Policy Format. Notification of 1Q2015
Knowledge Pack and NCCI edit update.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna
Health and Life Insurance Company and Express Scripts, Inc. The Cigna name, logo, and other Cigna marks are owned by Cigna
Intellectual Property, Inc. © 2020 Cigna.
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