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Know What Should Be Coded and Documented
Act
immediately
Effective date
Not stated in the notice
Identified
Oct 3, 2026
Summary
This policy clarifies coding and documentation requirements for Horizon Blue, emphasizing that only conditions that are Monitored, Evaluated, Assessed, and/or Treated (MEAT) during a visit should be coded and reported. Providers must document diagnoses in the Assessment/Plan section of records, not just in problem lists or history/physical exams, and must follow specific SOAP format requirements. Documentation must support face-to-face or telehealth encounters and include provider credentials with signatures dated within 30 days of service.
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What to do
immediately · 13 steps
01Billing and clinical teams must implement the following documentation and coding requirements for all Horizon Blue claims.
02Providers must document all billable diagnoses in the Assessment/Plan section of encounter notes, not in problem lists or history alone.
03Billing team must verify that coded diagnoses align with MEAT criteria (Monitored, Evaluated, Assessed, and/or Treated during the current visit).
04Do not code conditions from previous visits unless actively managed at current encounter.
05Do not code unconfirmed diagnoses (probable, possible, suspected, working diagnoses).
06Ensure all medical records follow SOAP format (Subjective, Objective, Assessment, Plan) with complete provider credentials and signatures dated within 30 days of encounter.
07For status conditions (transplant, amputation, dialysis, chemotherapy, artificial openings), document and code at least once annually.
08Code co-existing conditions only when documentation shows they affect treatment or management.
09Stop using arrows or symbols alone to indicate diagnoses.
10Update EMR templates and encounter forms to enforce Assessment/Plan documentation requirements.
11Train all clinical staff on MEAT coding criteria.
12Implement claims review process to verify documentation support before submission.
13Non-compliance will result in claim denials and potential overpayment recoupment.
Original notice
Know What Should Be Coded and Documented
horizonblue.com · Always check the source before changing claims.