Claims edits

Follow CPT coding guidelines to prevent claims auditing editing from resulting in claim denials. Claims auditing edits will be explained by a message code on the remittance advice.

The auditing tool also includes, but is not limited to, the following edit categories*:

  • Age conflicts
  • Alternate code replacements
  • Assistant surgeon requirements
  • Cosmetic procedures
  • Duplicate and bilateral procedures
  • Duplicate services
  • Gender conflicts
  • Incidental procedures
  • Modifier auditing
  • Mutually exclusive procedures
  • Preoperative and postoperative auditing billed
  • Procedure unbundling
  • Unlisted procedures

*The complete set of code edits is proprietary and, as such, cannot be released to the public.

TRICARE claims information