Smart Edits alert you of any claims that can be repaired and resubmitted prior to a denial. The result is a quicker and less time-consuming process for your 837 electronic claim billing routine. See an example with time saved in the electronic claims flow with and without Smart Edits.
These edits are displayed on the 277CA electronic reports. If you are not familiar with this report, consult with your electronic billing department or your billing service/clearinghouse. The 277CA is an electronic report available shortly after the electronic claim file is submitted. This report is a routine part of the billing process that advises whether the claims submitted were sent to the processing system or not. Claims may reject on this report for a variety of reasons.
Smart Edits were recently added to analyze additional claim data and identify coding or processing errors. Some claims are rejected by a Smart Edit and do not enter the claims processing system. These claims must be corrected and resubmitted. Other Smart Edits are informational only and will still be passed to the claims processing system for payment consideration.
It is imperative that the 277CA reports be reviewed carefully with every electronic claim file submission. The 277CA electronic report will provide a rejection code/flag. Reference the following resources to identify the associated message and determine what corrective action is needed:
Identify problematic claims sooner.
Clear notifications on how to fix claim errors.
Reduce time spent on claim resubmissions.
1. Access the 277CA.
2. Review the STC*12 segment in the 2220D loop(s).
3. View the online Novitas Smart Edit List. (Part A
) (Part B
4. Find the pattern number or message displayed in the STC segment on the Smart Edit list.
5. Review the instructions to resolve the edit and decide if you will need to update the claim and resubmit.
If the message is informational only - no updates or resubmission is needed. Claims with informational messages will be passed to the claim processing system for adjudication.
If updating the claim - make the necessary changes and resubmit at any time.
If you want to submit the claim as-is, you must wait 24 hours and then resubmit. The Smart Edits will not prevent the claim from being sent to processing after 24 hours have elapsed from the first submission. If the claim is resent, without changes, prior to the 24 hours wait period, the Smart Edits will reject the claim as a duplicate.
Smart Edits were initially introduced in July 2023 and additional Smart Edits will be incorporated routinely. The Novitas Smart Edit Lists (Part A) (Part B) include the effective dates and are updated as with new edits as they are introduced. Notification of new edits will also be sent to our email lists as notification. Please make sure you are signed up, receiving, and reviewing those emails. If you are not currently receiving those emails, join here.