Claim Edit For Free - Types Of Claim Edits

While there are universal or standard claim edits such as National Correct Coding Initiative (NCCI) Edits, Global Edits, and Correct Coding or ICD-10-CM Edits, these types of edits do not cover all requirements for large medical groups.

What are claim edits? According to Healthcare Innovation, healthcare claims editing is a step in the claims payment cycle that involves verifying that physician-submitted bills are coded correctly. Large medical groups must contend with claims that are high in volume and complexity.

These edits improve claim quality and decrease the amount of time a claim spends in the process. If a claim fails our edits, our billing specialists and certified coders work on it until the claim is acceptable to bill. Other companies send claims out and then try to correct them after they're denied by the payer.

Although most commercial payers use the publicly available code edits, including the hundreds of thousands of claim edits published pursuant to the Centers for Medicare and Medicaid Services' (CMS) National Correct Coding Initiative (NCCI), these payers also use a host of proprietary payer-specific edits.

CES contains edits for both professional and facility claims that are specific to each claim type. The NTIS software provides Oxford with the Correct Coding Rules used by CMS.The CES software incorporates the quarterly updates that CMS makes to the Correct Coding rules into Oxford's claims processing system.

CES contains edits for both professional and facility claims that are specific to each claim type. The NTIS software provides Oxford with the Correct Coding Rules used by CMS.The CES software incorporates the quarterly updates that CMS makes to the Correct Coding rules into Oxford's claims processing system.

For the physician fee schedule, there are two basic types of code edits: the Correct Coding Initiative (CCI) and the Medically Unlikely Edits (MUEs). Each edit type is designed to perform a different function.