Accurate Claim Coding Focus for Member Campaign

Accurate claim coding is a cornerstone of quality care and compliance, particularly during our member engagement risk adjustment campaign, which runs through December. This initiative is designed to improve patient outcomes and ensure the proper capture of health data. If you work in a hospital or clinic, here’s what you need to know and do:

What you need to know
Accurate coding impacts risk adjustment scores and helps providers reflect patient complexity appropriately. Coding errors, such as omitting chronic conditions, neglecting comorbidities, or inaccurately capturing preventive care services, can lead to compliance issues and missed opportunities for effective care coordination.

What action to take
Hospital and clinic staff should regularly review patient records and make sure clinical documentation supports submitted codes. Pay special attention to commonly mis-coded conditions, such as:

• Diabetes with complications
• Heart disease
• Hypertension

Use resources like our provider tipsheets to refine your coding practices.

What’s changing
This campaign emphasizes proactive care management and member engagement, focusing on chronic conditions that require precise coding and follow-up. It also highlights the need for thorough documentation to accurately reflect patient health status.

More information
If you have questions, email MemberEngagement@Premera.com.