NCE Began October 4, 2020

As previously educated, Noridian Custom Edits (NCE) integration is complete and went live October 4, 2020.

NCE will populate in the Status Information (STC) segment of the 277CA with distinct code sets that can be cross-referenced to the NCE Spreadsheet. To assist with NCE review, Noridian established an edit spreadsheet, which can be found at http://www.edissweb.com/cgp/reports/. This listing will be updated as new edits are created and rolled out.

NCE will be reported in the 2200D STC and 2220D STC segments. The edit message will be in STC12. See an example below:

STC*A3:23:41**U*********SMARTEDIT PATTERN 45 PER MEDICARE GUIDELINES TEAM SURGERY IS NOT PERMITTED FOR PROCEDURE CODE 99214.~

NCE enhance claims editing for both providers and payers and 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

            Last Updated Wed, 07 Oct 2020 13:57:42 +0000