Noridian Custom Edits (NCE) to Begin Sunday, October 4, 2020

FOR All NORIDIAN Medicare Claims Submitters

Noridian Custom Edits (NCE) integration is complete and will go live October 4, 2020.

NCE will populate in the STC elements of the 277CA with distinct code sets that can be cross referenced to the NCE Spreadsheet. To assist submitters’ NCE review, Noridian established an edit spreadsheet at http://www.edissweb.com/cgp/reports. This listing will increase as new edits are created and rolled out.

NCE will be reported in the 2200D STC and 2220D STC segments. The edit message will be in STC12. An example is included below:

STC*A3:23:41**U*********SMARTEDIT PATTERN 17198 PER MEDICARE GUIDELINES USE OF MODIFIER RH IS NOT TYPICAL FOR PROCEDURE CODE A0394.~

NCE enhance claims editing for both providers and payers and integrate with existing claims acknowledgement reporting (277CA) on 837 electronic claim submissions.

NCE allow Noridian to do the following:

• Help identify problematic or ”certain to deny” claims prior to Noridian claims processing
• Alert providers of errors and potential claim processing issues around medical necessity, non-covered services, missing modifiers, and other clinical editing
• Deliver timely and clear notifications of how to fix claim errors
• Save administrative time tied to claim resubmissions
• Improve transparency of claim editing and claims processing