Advanced Communication Engine
Effective Jan. 1, 2018, HealthChoice has adopted industry standard claim editing guidelines. These guidelines are a combination of CMS, CCI, and McKesson claim editing criteria which have been evaluated for implementation based on plan experience.
To ensure our network providers have the best possible experience with our organization, we launched our new Advanced Communication Engine system. ACE is available to all direct submitters as well as those who transmit claims via clearinghouses or billing services. ACE Edits will appear on claim rejection reports (277CA).
- ACE alerts you to deny certain claims through claim acknowledgement transaction reports with clear instructions on how to fix the error and access the supporting documentation that triggered the alert.
- Claims failing the pre-adjudication editing process are not forwarded to our claims adjudication system.
- ACE integrates into your current EDI workflow so you can modify claims before submission.
- After you have reviewed the ACE Edit, if you choose not to change the claim, you can resubmit in its original format and it will pass directly into our claims adjudication system for processing.
ACE does not require any downloads or changes in your current EDI work stream, and it’s available to you at no cost. Help improve clean claim rates and increase collections with actionable edit intelligence.
Providers should work with their existing clearinghouse/billing service to stress the importance of receiving a full 277CA claim submission report to include the ACE Edits.