Claims processing edits

We regularly update our claim payment system to better align with American Medical Association Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) and International Classification of Diseases (ICD) code sets. We also align our system with other sources, such as, Centers for Medicare & Medicaid Services (CMS) guidelines, correct-coding initiatives, Humana policy, national benchmarks and industry standards.

We post notifications of upcoming changes to this page on the first Friday of each month.

These notifications inform providers that we plan to make a change to our code editing rules or claim payment processes. An individual notification may not describe previously implemented rules that still apply; the intent is to give notice of an upcoming change. Previously published notifications are available on this page for at least five years. A notification may be removed after five years, or sooner if the notice no longer applies.

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You can enter a keyword or keywords in the search box below to search for notifications about a topic. The more specific you are, the more pertinent your results will be. For example, if you enter "air ambulance" instead of "ambulance," your search will return only notifications in which the words "air" and "ambulance" appear, versus all notifications that mention "ambulance."

Notifications for the Puerto Rico market

For notifications that impact the Puerto Rico market, select display edits for the Puerto Rico market only. These notifications are displayed in Spanish.

Reminders and special announcements

Please review the “General reminders and special announcements” page for important information that applies to all code editing and claim submissions.