Each quarter, the American Medical Association CPT® and the Centers for Medicare & Medicaid Services (CMS) release updates to their respective code sets. EmblemHealth and ConnectiCare strive to update their claims processing systems to reflect the coding changes within 60 days of the release.
To pay you faster, we are implementing a new code-loading process and a new payment integrity policy: CPT/HCPCS New Code Updates.
Currently, if a claim is billed with a new code that is not in our system yet, we hold the entire claim while the new code is being loaded.
Starting in July 2024, our claims systems will adjudicate all services except for the ones with new code(s) that are not yet in the system. Once the new CPT and/or HCPCS code(s) is in our claims system, we will reprocess the claim to adjudicate the outstanding claim line(s).