May 1, 2009

Dear Peach State Provider:

Peach State Health Plan (Peach State) uses code editing software to assist in improving the accuracy of its claims processing, payment, and reporting. Our current code editing software is being phased out by the manufacturer; as a result, Peach State will begin utilizing an updated and expanded version developed by the same company, effective  August 1, 2009.

The code editing software will ensure that Peach State continues to process claims in accordance with generally accepted industry coding standards by applying the appropriate conventions set forth in the health insurance industry, such as the Center for Medicare and Medicaid Services (CMS) Correct Coding Initiative policies, current health insurance and specialty guidelines, and the American Medical Association’s CPT Assistant newsletter. In addition, this new software will be utilized on all outpatient hospital claims to assure proper coding and billing. As with the past code editing software, the updated software is HIPAA compliant.

This letter serves as your official 90-day notification of Peach State’s intent to move to the upgraded software. As the effective date approaches we will provide more detailed information on the software and its functionality. In addition, the Provider Manual, Web site, and Clear Claims (the online coding assistant) will be updated once the changes become effective.

Should you have any questions about this notification please call Peach State’s Provider Solutions Department at (866) 874-0633.

This entry is filed under News.