Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21

Policy Number

Policy Name

Policy Description

Lines of Business

CC.PP.070

340B Drug Payment Reduction

Ensures that providers participating in the 340B Drug Pricing Program are correctly reporting 340B acquired drugs according to guidelines established by the Centers for Medicare and Medicaid Services (CMS).

Medicare

CP.MP.208

Outpatient Testing for Drugs of Abuse: Presumptive Frequency Edits

Medical necessity criteria for presumptive (preliminary) testing for a specific drug and frequency limits for 80305, 80306, and 80307 for chronic opioid therapy.

Medicaid, Medicare, Marketplace

Policy Number

Policy Name

Policy Description

EX Code

Lines of Business

Prepay Edit

WCG Integration Value Capture – Correct Coding Batch 2 (Cotiviti 8, WCIVC B2)

The purpose of this policy is to serve as a reference guide for general coding and claims editing information. Cotiviti 8 is a correct coding edit of ICD-10 diagnosis codes. Source: ICD-10 CM Diagnosis Code Manual 

EX Code: wd Diagnosis Code Incorrectly Coded Per ICD10 Manual

Medicaid, Medicare, Marketplace