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Claims Policy and EDI Documents

Health Plus applies the PACE criteria developed by Deloitte & Touche in our payment system. Upon appeal Health Plus consults and follows the guidance provided by the National Correct Coding Initiative (CCI) edits and where these differ from PACE, the CCI guidance will prevail.

In the event of an appeal regarding the effect of clinical edits upon payment for a claim, Health Plus will follow the guidance of the Medicare Correct Coding Initiative, as periodically promulgated by the Centers for Medicare and Medicaid Services (CMS) and periodically revised.

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