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August 2019 Humana News: Advanced Claims Editing (ACE) Helps You Identify Potential Coding Issues in Batch Claims Up Front

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08/01/2019

Advanced claims editing (ACE) helps you identify potential coding issues in batch claims up front.

All electronic data interchange (EDI) submissions to Humana pass through Availity before they enter Humana’s system. A process known as advanced claims editing (ACE) applies certain coding rules to batch medical claims submitted through the Availity gateway via EDI. This allows claims submitters to identify potential coding issues up front and to reduce processing delays that can result from incomplete or inaccurate claims data.

If a potential coding issue is identified, the claim will be “returned” with enhanced messaging on the electronic batch record (EBR) or electronic benefit transfer (EBT), the reports that provide HIPAA and payer-specific edits (PSE). This messaging will inform you about rules that may be applied and provide an opportunity to update the claim coding for faster processing.

Check out this flyer to learn more about ACE and how it can help you.

Find more about Humana’s claims policies and processes at Humana.com/MakingItEasier.