Correct Coding Keeps Claims Moving

LifeWise Health Plan of Washington uses claims editing tools to make sure the medical claims you send are accurate and complete. Sending correct claims using the right code helps your payments go through faster and lowers the chance of delays or denials.

Why it Matters

We regularly add new coding rules to our claims editing tools to help keep provider billing accurate. All claims must follow standard industry coding guidelines.

What we Follow

These accepted coding resources support accurate billing and claims:

• Coding policies and coverage decisions from the Centers for Medicare & Medicaid Services (CMS), including local and national guidance
• Procedure codes and guidelines from Current Procedural Terminology (CPT) and the Healthcare Common Procedure Coding System (HCPCS)
• Diagnosis-related group (DRG) guidelines
• Coding guidelines from the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
• Coding and clinical guidelines from nationally recognized medical academies and professional societies
• Guidance from the National Uniform Billing Committee (NUBC)
• Official UB-04 Data Specifications Manual

Your Role

As a provider, you’re responsible for submitting claims that are accurate, specific, and supported by your medical records.

• Match codes that clearly reflect care, services, or items you provide.
• Make sure procedure codes are supported by the related diagnosis codes.
  • For example, when removing a cutaneous or subcutaneous lesion, use the appropriate integumentary system CPT codes (11400-11471 and 11600-11646).
  • Soft‑tissue excision codes (21011-21014 and 21552-21556) aren’t supported for these services and shouldn’t be used.
• Use the most specific diagnosis code when it’s documented in the medical record or reported on the same claim.
  • For example, don’t bill an unspecified primary malignant neoplasm code (such as C80.1 – Malignant (primary) neoplasm, unspecified) when a more specific diagnosis is available and billed at the same encounter (such as C00.0 – Malignant neoplasm of external upper lip).
• Ensure your medical record clearly supports every code billed.
• Submit complete, accurate claims that follow billing and coding rules.

Claims that don’t meet guidelines may be delayed, denied, or adjusted. Check our payment policy page for more info.