Enhancements to Martin's Point Claims Editing

Dear Provider,

Thank you for your participation in the Martin’s Point Generations Advantage network.

To ensure transparent, timely, and accurate reimbursement practices aligned with regulatory requirements, industry standards, and best practices in claims management, Martin’s Point is enhancing our claims editing processes.

Starting December 6, 2025, Martin’s Point will begin implementing an enhancement to our claims editing processes for Generations Advantage that promotes correct coding. The goal of this endeavor is to implement claim payment practices that align with regulatory requirements and are simple to understand. Martin’s Point believes this will enable you and your billing staff to more readily understand our payment of claims.

These enhancements take into consideration Martin’s Point Health Care’s historical claims experience as well as guidelines from the following sources:

• AMA CPT coding guidelines
• National and Regional Medicare policies
• National specialty academy guidelines

Martin’s Point’s claims edits focus on areas such as, but not limited to, the following:

• AMA CPT procedure code definitions and guidelines
• National Correct Coding Initiative (CCI)
• Modifier usage
• ICD diagnosis code guidelines
• Global surgery period
• Evaluation and Management guidelines
• Add-on code usage
• Professional, technical, and global policy
• Diagnosis to procedure relationships
• Place of service
• Age appropriateness
• CMS National and Local Coverage Determinations
• Revenue code validation

To view our General Claims and Billing policy, please click here.

If you have any questions regarding this notification, please contact Martin’s Point Provider Inquiry at 1-888-732-7364.

Thank you for your continued partnership.