In part one of this four-part series, we reviewed the fundamental changes being introduced the American Medical Association’s (AMA) maternity care coding effective January 1, 2027. In part two, we examined the misalignment and current uncertainty evidenced by opposing responses from industry leadership. Part three presented the opportunity these changes offer health plans that are willing to prepare ahead of time.
In this final installment, we’ll share what claim editing solution vendors should be doing at a high level within claim editing to prepare for the 2027 changes.
Preparing for change
If you haven’t already, you should be asking your claim solution vendors if they’re on track and well-positioned to support health plans through the encounter-based maternity care code transition. Preparation should involve Content Operations, Product, Clinical Delivery, and client-facing teams at a minimum, with work focused on translating the new coding framework into updated payment policies, clinical editing logic, and client-specific implementation plans.
Here is our recommended five-stage implementation path:
- Assess: Map affected codes, policies, rules, and configurations
- Develop: Create and update rules to align with the new CPT guidelines
- Test: Evaluate representative maternity claim scenarios
- Deploy: Implement remaining updates before January 1, 2027
- Monitor: Review claim volumes, denial patterns, and provider feedback
In closing
Health plans should use the remaining implementation period to evaluate their policies, configurations, provider communications, and testing plans. Cotiviti is preparing its clinical editing systems, payment policies, rule guidance, and client-specific configurations to support the new maternity framework before January 1, 2027.
As final guidance develops, Cotiviti will continue to monitor the industry's response and help clients navigate the transition with the flexibility required for an evolving regulatory environment.
If you have questions around maternity coding changes or would like to learn more about how Cotiviti is helping our clients with January 1 maternity code compliance readiness, request a conversation, speak to your primary representative, or share you questions at answers@cotiviti.com.
