Claims Processing Update

Posted 31 May 2012 by egatton & filed under Provider News.

Kentucky Spirit Health Plan is planning to enhance the edits in our claims processing system to more closely align withHIPAA standards and CMS billing requirements. Until now, several edits have been considered ‘soft’, meaning that aclaim could pass through the claims system even if the edits were not met. When these claims are turned to ‘hard’ edits,billing errors will result in upfront claim rejects or a denial of the claim or claim lines in our processing system.

The following are examples of the edits that will be turned to ‘hard’ edits effective July 1, 2012. Read more…