Hennepin Health implemented three new upfront editing processes on August 1, 2016. Upfront editing (also known as pre-processing logic) allows for the claim data elements to be validated against a series of rules and edits that ensure the claim and the claim detail abide by the health plan’s policies and procedures. These edit functions verify the accuracy, validity, required presence, format, consistency, and allowable values against the claim data elements submitted for consideration before the final adjudication and disposition of the claim. A soft code edit consisting of a warning message for the edited claim will continue through October 31, 2016. The hard code edit (claim rejection) will become effective November 1, 2016.
More information can be found in the full bulletin.