The following steps should be taken when a physician or other qualified health care professional finds that a payer’s code edits prohibit appropriate payment for a charge for medically necessary services (when billed correctly based on coding guidelines):

The advocacy of national physician specialty organizations such as the AAP can affect how code edits are implemented, revised, or deleted from the National Correct Coding Initiative and with national or large regional health plans. Establishment of relationships with local and regional health plan administrators at the state or regional level has been shown to be more effective with advocacy to those plans.

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