Absolute Total Care Payment Policy and Edit Updates Effective 5/1/21

Date: 04/24/21

Thank you for your continued partnership with Absolute Total Care. As you know, we continually review and update our payment and utilization policies to ensure that they are designed to comply with industry standards while delivering the best patient experience to our members. We are writing today to inform you of new policies Absolute Total Care will be implementing effective *5/1/2021*.

Policy Number	Policy Name	Policy Description	Lines of Business
CC.PP.070	340B Drug Payment Reduction	Ensures that providers participating in the 340B Drug Pricing Program are correctly reporting 340B acquired drugs according to guidelines established by the Centers for Medicare and Medicaid Services (CMS).	Medicare
CP.MP.208	Outpatient Testing for Drugs of Abuse: Presumptive Frequency Edits	Medical necessity criteria for presumptive (preliminary) testing for a specific drug and frequency limits for 80305, 80306, and 80307 for chronic opioid therapy.	Medicaid, Medicare, Marketplace

Policy Number

Policy Name

Policy Description

EX Code

Lines of Business

Prepay Edit

WCG Integration Value Capture – Correct Coding Batch 2 (Cotiviti 8, WCIVC B2)

The purpose of this policy is to serve as a reference guide for general coding and claims editing information. Cotiviti 8 is a correct coding edit of ICD-10 diagnosis codes. Source: ICD-10 CM Diagnosis Code Manual

EX Code: wd Diagnosis Code Incorrectly Coded Per ICD10 Manual

Medicaid, Medicare, Marketplace

For detailed information about these policies, please refer to our website at www.absolutetotalcare.com.

For questions about this or any of our payment policies, please don’t hesitate to reach out to our Provider Services team at 1-866-433-6041.