Improving Electronic Claims Processing with Noridian Custom Edits (NCE)

To decrease the provider burden associated with claim-related administrative costs, Noridian is integrating Noridian Custom Edits (NCE) into our Electronic Data Interchange (EDI) gateway for electronic claims processing. NCE enhance claims editing for both providers and payers and will integrate with existing claims acknowledgement reporting (277CA) on 837 electronic claim submissions.

NCE allow Noridian to do the following:

  • Help identify problematic or “certain to deny” claims prior to Noridian claims processing
  • Alert providers of errors and potential claim processing issues around medical necessity, non-covered services, missing modifiers, and other clinical editing
  • Deliver timely and clear notifications of how to fix claim errors
  • Save administrative time tied to claim resubmissions
  • Improve transparency of claim editing and claims processing

NCE will populate in the STC elements of the 277CA with distinct code sets that can be cross referenced to the NCE Spreadsheet. To assist submitters’ NCE review, Noridian will establish an edit spreadsheet at http://www.edissweb.com/cgp/reports/.

Rollout of NCE is slated for late September, and Noridian will continue educating on this change in the coming weeks.

 

            Last Updated Mon, 21 Sep 2020 21:03:29 +0000