Coding Toolkit

Claim edits updates

We implement quarterly updates to edits approximately one month after the effective date retro-active to the 1st day of the quarter (excludes outpatient code editor (OCE) edits). Claims received before our systems are updated will not be adjusted.

Recent implementation dates

Quarterly implementation dates archive

  • 4th quarter implementation date: 10/29/2022
  • 3rd quarter implementation date: 7/31/2022
  • 2nd quarter implementation date: 5/1/2022
  • 1st quarter implementation date: 1/30/2022
  • 4th quarter implementation date: 10/24/2021
  • 3rd quarter implementation date: 7/31/2021
  • 2nd quarter implementation date; 4/25/2021
  • 1st quarter implementation date: 1/31/2021
  • 4th quarter implementation date: 11/1/2020
  • 3rd quarter implementation date: 7/26/2020
  • 2nd quarter implementation date: 4/26/2020
  • 1st quarter implementation date: 1/26/2020
  • 4th quarter implementation date: 10/27/2019

NCD and LCD updates

We implement updates on National Coverage Determinations (NCDs)/Local Coverage Determinations (LCDs) within one month of receipt/delivery of edits from Change Healthcare. NCD/LCD updates will be effective retro-active to the date specified by the Centers for Medicare & Medicaid Services (CMS) or Noridian. Claims received before our systems are updated will not be adjusted.

Claim processing information

We provide claims processing information in an ANSI 835 Electronic Remittance Advance (835 ERA) format. We use Group Code "PI" (Payer Initiated Reductions) and do not use Group Code "OA" (Other Adjustment) except for the codes indicated on the Claim Adjustment Reason Code (CARC) list.

To understand why a claim was denied, view the external code lists on the wpc-edi website. View the Explanation Code (EXCD) ANSI code crosswalk document.