Claims Editor

Using the Claims Editor Tool

The Claims Editor tool allows users to review codes against:

• CCI edits
• National Coverage Determinations (NCDs)
• Local Coverage Determinations (LCDs)
• Medically Unlikely Edits (MUEs)

Getting Started

1. Select your location from the dropdown menu.
2. Choose:
   • Practitioner or Hospital CCI edits
   • Non-Facility or Facility RVUs

Entering Procedure Details

For each row, enter the following:

• Date of Service
• CPT/HCPCS code and units of service
• Modifiers
• Diagnosis (ICD-10-CM) codes

To add more than two procedures, click the “Add another procedure” button at the bottom of the screen.

Understanding the Results

Once you've entered all relevant information, the tool will display results in the right column. These may include:

• Impacts on Risk Adjustment scores based on diagnosis codes
• Advice on applying modifiers when appropriate
• Notices about potential conflicts or warnings

Important: Red comments indicate potential concerns, such as:

• Exceeding MUEs
• Medical necessity issues

Watch: Claims Editor Tutorial