Institutional Edit Maintenance by Claim Type

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To make changes to your institutional edits, from the ClaimStaker toolbar select Configuration then Edit Maintenance and then Institutional Claim. The Institutional Edit Maintenance by Claim Type page appears. There are several columns on this page. Edit Number, Edit Name, Edit Category, and Edit Severity relate specifically to an edit. The BC/BS (Blue Cross/Blue Shield), Tricare, Commercial, Medicaid, Auto, Workers Comp, Medicare, and Medicare Advantage columns allow you to customize the edits applied to your submission files during the claim scrubbing process by providing check boxes that control whether a specific edit is enabled or disabled for a particular claim type.

Screenshot of the Institutional Edit Maintenance table with eleven columns and three rows of edits. Edits are enabled for different claim types by the selection of check boxes in the edit rows and under the claim type columns.

Viewing and sorting institutional edits

By default, institutional edits are sorted by edit number; however, they can be resorted in ascending or descending order by selecting the link in the Edit Name, Edit Number, Edit Category, or Edit Severity column headers.

To learn more about a specific edit, select the edit name link in the Edit Name column. A description of the edit appears in a separate window. Click OK when done to close the window.

Screenshot of the Institutional Edit Maintenance table. After selecting an item under Edit Name column, a description of the edit opens. Here, the edit 15050 is selected. A description opens that says: The value code A8 is used to indicate the patient's weight in kilograms. Patient weight is required on ESRD claims.

Configuring institutional edits

There are three ways to make changes to institutional edit configurations:

  1. Configure individual edits for a particular claim type – Simply select check boxes for the desired edits under the appropriate claim type column to enable or disable individual edits for that claim type.

    Screenshot of the seven claim type columns and three rows of check boxes. A check box un</li>der the Tricare column is being selected.

  2. Enable or disable all claim types for a specific edit – Select the check box under the Select column for a specific edit to enable or disable the edit across all claim types.

    Screenshot of all eleven columns on the Institutional Edit Maintenance table and three rows of edits. A check box under the Select column for the CPT/HCPCS Code Validation edit is being selected. All the check boxes for all claim types are now checked/enabled for that edit.

  3. Enable or disable all edits for a specific claim type – Select the check box above a specific claim type name in the column header (e.g., BC/BS, Commercial, Medicare, etc.) to enable (check) or disable (uncheck) all edits for that claim type.

    Screenshot of two of the claim type columns. The check box above the Comercial claim type column header is being selected. All the check boxes under the Commercial column are now checked/enabled.

When done, click Apply. A message displays indicating the edits were successfully updated.

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