We have the right to review claims. This helps ensure that care providers follow nationally accepted coding practices and that we paid at the correct allowance. Please cooperate with our review of claims and payments. We may request access to claim information and supporting documentation.
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- Care Provider Administrative Guides and Manuals
- Administrative Guide for Commercial, Medicare Advantage and DSNP
- Our Claims Process - Ch.9, 2019 Administrative Guide
- Medical Claim Review - Ch.9, 2019 Administrative Guide
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