On July 12, 2018, Hennepin Health’s claims system was enhanced to include the use of Optum Claim Edit System™ (CES) software. The enhancement is applicable for all new and adjusted professional (837P) and institutional (837I) claims for Hennepin Health-PMAP, Hennepin Health-MNCare and Hennepin Health-SNBC members.
What is claim edit software, and why did Hennepin Health implement the software?
Most health plans utilize some type of software to apply particular edits on incoming claim transactions. The software reviews claims to check for duplication, missing information, coding relationships and other requirements, and ensure compliance with health care claim industry standards, regulations and policies. The software identifies errors and applies the applicable explanation code related to the error(s) identified on a claim. Hennepin Health implemented the CES software to improve efficiency and accuracy in the claims review process.
Hennepin Health routinely monitors claim errors identified by the CES software to confirm the edits are applied appropriately.
Other than new denial reasons appearing on a provider’s remittance advice, there should be minimal impact to providers. If you have questions or concerns related to this change, please contact Hennepin Health Provider Services at 612-596-1036 (select option 2). For more information about Optum Claim Edit System™ software, please visit their website.