When an electronic claim gets sent from MacPractice, it gets uploaded at Change Healthcare and their computer system goes through a series of checks, called edits, to ensure that all claims are sent with a certain level of accuracy. There are additional edits that can be placed on the account that are called CCI/MNC (Correct Coding Initiative/Medical Necessity Checking) edits. These edits will check the accuracy of CPT/HCPCS codes that are submitted as well as what diagnosis codes are linked to them. They will let the submitter know if they are billing certain codes the correct way for a particular payer, and will notify you if you do not meet medical necessity. The purposes of these edits is to let the user know sooner that the claim is going to be denied by the payer.
Change Healthcare will run each claim through their normal set of edits to check for missing/invalid information based on ANSI (American National Standards Institute) guidelines. They will also take payer requested edits into consideration; like SmartEdits. After the claim get sent through this series of edits, the claim can then go through CCI/MNC edits before being sent on to the payer. If a claim does not pass these coding edits the claim will reject because of some deeper level coding issue. If the office has purchased the Change Healthcare Portal option they will be able to view the reason for rejection. Often times there will be a small bit of information regarding the error and how to go about correcting it. If an office does not have the Portal option, they can contact MacPractice Support for further information.
Note: If enabled, the CCI/MNC edits can be turned off for a particular payer. To do this please contact MacPractice EDI Support for more information.