Clinical edits tool launching
(October 27, 2011)
We're excited to introduce a new tool for providers that will show you how clinical edits will be applied to future claims, and how edits have been applied to processed claims. Effective for claims processed Jan. 22, 2012, the OPTUMInsight™ (formerly Ingenix®) tool known as iCES will enhance claim processing in several ways.
- The "what if" component, called Edits Checker, shows providers how claims will pay - just enter sample test billing and diagnosis code options.
- The claims processing component cuts Priority Health processing turnaround time, for faster claims payment with automatic adjudication rates.
- Transparency is improved, because the tool displays clearly defined editing rules and sources.
- Streamlined clinical edit definitions follow national and industry standards.
- Faster clinical edit review - this feature is available right in the tool.
Where to find clinical edits information
The new Edits Checker "what if" tool will be available to logged-in providers in their list of online tools. For claims already processed, a new "See edits" link will appear on the claim screen. Clicking it will show you how the iCES application applied clinical edits to the claim, with sources for the editing rules.
Look for this new tool beginning with claims processed on Jan. 22, 2012.
