Payment Integrity Policies
The policies below apply to 2026/2025 commercial and 2025 Medicare Advantage plans:
Annual Fee Schedule Update
Claim Review Program
Coding Validation
CPT/HCPCS New Code Updates
Device, Implant and Skin Substitutes Coding Guidelines (Facilities)
Hospital Inpatient - Routine Supplies & Services
Laboratory Benefit Management Program
Pre/Post Pay Claim Reviews Policy
Sepsis Coding - Pre/Post Claim Review
