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Claims Processing Policies and Procedures

 

Significant Edits – View a list of edits that affect at least 500 claims per year and differ from AMA CPT or CCI coding guidelines.

 

Customized Edits - View a list of edits added to standard claims editing logic by Humana.

 

Modifier 59 Edits - View a list of code combinations that Humana has determined are not appropriately reported together with a modifier 59 and which differ from AMA CPT coding guidelines.

 

* The policies and guidelines addressed above are not an all-inclusive listing.

 

 

 

 

 

 

 



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