Receive Faster Claim Notifications with Noridian Smart Edits

To assist providers with faster claim resolutions, Noridian has installed multiple Custom Smart Edits (NCEs) to give upfront notifications when a claim is billed with incorrect information. This rapid response allows providers to immediately review their claim responses and correct them without having to wait for a remittance response. For example, if a procedure that bundles with another submitted code for the date will receive the below message:

"SMARTEDIT PATTERN 24078 PROCEDURE CODE (DENIED) CODE HAS AN UNBUNDLED RELATION WITH HISTORY PROCEDURE (PROCESSED PROCEDURE) BILLED ON THE SAME DATE OF SERVICE PER CCI GUIDELINES."

Providers are advised to thoroughly review these upfront edits before resubmitting electronic claims. The only time a rejected claim should be resubmitted without corrections is if provider needs a denied remit.

Resources

https://www.edissweb.com/cgp/reports/nce-pa.html

 

Last Updated Oct 02 , 2023