Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers


Additional coding edits applied to claims

Be sure to check the accuracy of all claims submissions

To identify common, industry-standard billing errors and issues, Magellan currently applies correct code edits to claims we receive (i.e., Centers for Medicare and Medicaid Services’ [CMS] National Correct Coding Initiative [NCCI] claim edits). We recently assessed even better solutions in applying consistent reimbursement using Medicare and other industry-standard coding guidelines.

Upcoming enhancements to Magellan’s code editing claims payment systems will allow us to align with other national industry standards that include, but are not limited to:

  • American Medical Association (AMA) Current Procedural Terminology (CPT®)
  • Healthcare Common Procedure Coding System (HCPCS)
  • International Classification of Diseases, 10th Edition (ICD-10).

These code editing updates will go into effect on Jan. 1, 2019.

You can find additional information on coding, including a link to CMS’ NCCI website page and other resources, in the Getting Paid section on

It is important that you stay up-to-date on edits that may affect your practice and payment for care, and to ensure the accuracy of all claim submissions.

Thank you for your attention to accuracy in your claims submissions. As always, we remain fully committed to reimbursing you accurately and promptly.

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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