Navicure’s® medical necessity edits
are designed to reduce medical necessity claim
submission errors. These edits examine Medicare
claims and identify errors prior to sending the
claims for adjudication. This enables your practice
to correct and resubmit claims immediately, rather
than waiting at least 14 days for a response from
Navicure's medical necessity edits help practices:
- Improve cash flow by correcting and resubmitting
- Avoid lengthy appeals by flagging procedure
codes that don't have supporting diagnosis codes.
- Reduce medical necessity write-offs by ensuring
all necessary diagnosis codes are present prior
to submission to Medicare.
These Navicure edits will ensure that Medicare
claims are in compliance with the National Correct
Coding Initiative (NCCI) developed by the Centers
for Medicare & Medicaid Services (CMS). CCI
edits identify pairs of services that normally
should not be billed by the same physician for
the same patient on the same day. The CCI includes
two types of edits – Comprehensive / Component
and Mutually Exclusive.
- Comprehensive/Component Edits identify code
pairs that should not be billed together because
one service inherently includes the other.
- Mutually Exclusive Edits identify code pairs
that, for clinical reasons, are unlikely to
be performed on the same patient on the same
If your practice has specific edit needs, Navicure
can develop custom edits just for you. By catching
errors on the front-end, you’ll be able
to increase the number or clean claims you submit,
enabling you to get paid faster.