Reducing Claim Rejections Using Intellect Edits
Because the 5010 requirements have changed, we've added several new edits to Intellect you can set up within the program. These include hard edits which do not allow you to continue until corrected, and soft edits which are warnings that allow you to continue without requiring changes.
For example, for billing procedures which require a referring provider, even when it is a self-referral, you can now set up an edit flag in the Utility Procedure record. When posting the charge, if you have not entered a referring source, the program will display a hard edit requiring you to enter a referring physician code, or allow you to search your referring table for the appropriate choice:
We’ve added the same edit feature when the Utility Procedure record indicates a modifier is required. During posting, if the modifier is left blank, the program will display a window with a hard edit:
Another common rejection we are seeing is for invalid diagnosis pointers.
For example:
Four diagnoses are entered for the date of service, and, during posting, the charges are linked to all four diagnoses. If, prior to committing the charges, one of the diagnoses is deleted, the claim would be billed with three diagnoses. However, the diagnosis pointer still has 1,2,3,4 – resulting in a rejection. In this scenario, Intellect will now display a hard edit requiring a correction before the charges can be committed:
The new edits described above are available in version 9.12.27 and greater.
Set up information is available in release note option January: 9.12.26 & 9.12.27 Versions under the first entry: MODIFICATIONS Charges --►Charge – New edits for Referring Provider, Modifiers and Diagnosis Pointer.
Intellect also contains edits for:
o Age and Gender for both Procedures and Diagnoses.
o Retired Procedures, Modifiers and Insurances, with option to display alternate choices.
o Validation of CPT code to diagnoses
o Global Follow Up days after surgical procedures
o Invalid Place of Service for the procedure posted
o Required Authorization Number, Hospital Admit Date and other encounter related information
o CCI edits for bundled procedures