Smart Edits

Smart Edits is a claims optimization tool that identifies billing errors within a claim and allows care providers the opportunity to review and repair problematic claims. These courses provide more details on each of the edits.

Smart Edits 101

Types of Smart Edits

Add-on Codes Smart Edit

Always Therapy Smart Edits

Anatomic Modifiers for Surgical Procedures (uAMSP)

Bundling/Unbundling Smart Edits

Clinical Laboratory Improvement Amendments (CLIA)

Coordination of Benefits (COB) Smart Edit

Discarded Drug Modifier

Evaluation and Management Level Review/Reconsideration Smart Edits

Expanded Exact Match Duplicate Smart Edits

ICD-10 CM Excludes 1 Code Pairs

Inappropriate Modifier

Inappropriate Primary Diagnosis Coding (IPDDN)

Invalid Procedure Diagnosis Smart Edits

Laboratory Smart Edits

LCD Part B Missing or Invalid Diagnosis

Missing Taxonomy Code (Texas Medicaid Only)

Molecular Test Z-Code Program (DEX)

National Drug Code (NDC)

New Patient Visit Smart Edits

Non-Covered Codes 

Ohio Nextgen Wrong Payer ID

Ordering and Referring Smart Edits

Preventive Service Included in Primary Procedure

Professional/Technical Component Based on Place of Service Smart Edits

Replacement Code Denials

Telehealth Smart Edits

Vitamin D Smart Edits