The Physician edit check for compliance tool will assist you in preventing claim denials. It does so by checking whether multiple CPT, HCPCS and ICD codes can be bundled/submitted together as per current Medicare edits, rules and regulations. ...
31 Nonetheless, because Aetna has modestly lower rates of challenging physician claims for any reason (ie, not only prior authorization),17 we may have underestimated the scope of prior authorization in Medicare Advantage if the rate of challenging claims is indicative of less prior authorization ...