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Updates to Claims Edit Software System

The following information was also provided via email on April 1. As a reminder, we’re sharing it here as well.

At Quartz, we care about giving you notice when changes are headed your way. Please note four updates coming soon to our Claims Edit Software System. These edits will be activated to begin June 1, 2022.

  1. Expansion of Billing Guidelines for Claims Submission: Quartz will activate edits to enforce proper billing procedures.
    • Inpatient facility claims should be filed in calendar order.
    • Claims submitted out of sequence could result in a denial of one or more claims.
  2. Notification for Anesthesia Modifiers: Quartz will implement an edit to deny claims missing the appropriate anesthesia modifier AA, AD, QK, QX, QY, or QZ.
    • One of these modifiers must be appended on a claim to denote whether an anesthesiologist or certified nurse anesthetist performed the service and if the service was personally performed, medically directed, or medically supervised.
    • Services previously reimbursed may no longer receive payment if appropriate modifiers are not applied.
    • This follows what is published in Quartz’s Provider Manual Medical Claims and Coding Policies (starting on page 52). 
  3. Expansion of Quartz Coding Policies: Quartz will activate edits to enforce CMS policy in accordance with Medicare NCDs and LCDs. 
    • Quartz is required by CMS to follow NCD and LCD policies for its Medicare Advantage line of business. Services previously reimbursed may no longer receive payment.
    • This follows what is published in Quartz’s Provider Manual Medical Claims and Coding Policies (starting on page 52). 
  4. Notification for Diagnosis Coding: Quartz will activate edits to enforce ICD-10-CM Official Coding Guidelines that provide instruction on the appropriate selection of codes, use of codes in combination with other codes, and the proper sequencing of codes. 
    • These edits will be enforced for all of Quartz’s lines of business. 
    • Services previously reimbursed may no longer receive payment if codes are not billed in accordance with the Guidelines.

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