Coding on the web: Aetna has a new system to check out payment before filing claim; check out SCODI

Why This Topic Matters

It helps providers understand that payer portals may show claim-edit outcomes before submission and that payer-specific policies can affect whether services are paid as expected. For ophthalmology offices, the article is especially relevant because it addresses a commonly discussed diagnostic imaging service and payer treatment of common co-management and bilateral billing scenarios.

Article Sections

1. Aetna policy update and online coding tools

   Introduces Aetna’s web-based policy resources and claim review tools available to providers. The section focuses on how the portal supports pre-billing review and edit visibility.

2. Co-management modifiers and payment policy context

   Discusses payer handling of common co-management modifiers and the broader context of payment policy guidance. It also notes why these modifiers can be especially relevant in ophthalmology.

3. Claim editing workflow and rationale display

   Describes the steps involved in using the claim editing tool and how disallowed items are presented to the user. The section also addresses payer-customized edits and supporting rationale information.

4. Bilateral procedure reporting note

   Provides a brief note about how the payer prefers bilateral services to be reported in its system. The section is limited to submission format concerns and portal behavior.