Professional Edit Maintenance by Claim Type

To make changes to your professional edits, from the ClaimStaker toolbar select Configuration then Edit Maintenance then Professional Claim. The Professional Claim Edit Maintenance by Claim Type page appears.

There are several columns on this page:

The Edit Number, Edit Name, and Edit Category columns 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. Using check boxes, you can control whether a specific edit is enabled or disabled for a particular claim type.

Screenshot of the Professional 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 professional edits

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

To learn more about a specific edit, select the edit name link under the Edit Name column. A description of the edit displays at the bottom of the page.

Screenshot of the Professional Edit Maintenance table. After selecting an item under Edit Name column, a description of the edit opens. Here, the edit CPT/HCPCS Code Validation is selected. A description opens that says, checks all CPT and HCPCS codes to confirm thare are valid codes for the date of service.

Configuring professional edits

There are three ways to modify professional edit configurations:

Configure individual edits for a particular claim type – Simply select the check boxes for the desired edits under the appropriate claim type column to enable or disable individual edits for that claim type.
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.
Enable or disable all edits for a specific claim type -– Selecting the check box above a specific claim type name in the column header (e.g., BC/BS, Commercial, Medicare, etc.) will enable (check) or disable (uncheck) all edits for that claim type.
When finished modifying your edits, select the Apply button. A message displays indicating the edits were successfully updated.

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