Claims Edit System
Our first-pass and secondary editing capabilities combine advanced technology and a wide range of content. We solve the largest editing challenges, improving claims accuracy and increasing savings.
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Solving editing challenges
Claims Edit System combines scalable, fully automated technology with robust content maintained by a team of specialists, medical directors and more. You can edit claim errors automatically for clinical coding and billing using a broad set of industry rules, regulations and policies. A dedicated support team helps seamlessly implement the system. They also assist with editing standard, specialty and custom rules.
Automated technology
It's more than an unbundling and editing tool. Claims Edit System features flexible editing functions and complete customization logic for proprietary business rules. The system automates claims review to catch errors, omissions and questionable coding.
Application Managed Services
Manage and maximize Claims Edit System with a dedicated Application Managed Services team that provides ongoing assistance. Our physician-led ideation team combines many levers to detect cost-saving opportunities to help you increase savings and ROI.
Robust, comprehensive content
In addition to national standard edits, including facility, professional, Medicare and Medicaid, we developed edit content for specialty analytic suites. These include specialty pharmacy, genomics and emergency services, among others.
Extend your editing capabilities
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Professional claims
Gain a wide set of core rules that use historical data to enhance your auditing capabilities for commercial, Medicaid and Medicare claims.
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Facility claims
Review and catch errors, omissions and questionable coding relationships automatically for commercial, Medicaid and Medicare claims.
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NCD/LCD
Add Medicare editing specific to National Coverage Determinations (NCD) and Local Coverage Determinations (LCD).
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National and state Medicaid
Deliver Medicaid-specific editing to help maximize your claims accuracy, as well as administrative and clinical information workflows.
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Specialty Rx
Implement specific edits for specialty medications.
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Emergency department
Manage emergent spend with editing content for outpatient emergency department facility and professional claims.