SHAPE Edit™ Features:

• Millions of edits, including payer-specific edits, for most commercial and government payers
• Millions of published & unpublished claim edits updated automatically every week
• Field-proven technology - tens of millions of claims processed to date
• Fatal and non-fatal errors explained in understandable language
• Automated one-click electronic claims submission

Supported Edits:

• Utilizes all seven WEDI/SNIP edit levels, while other programs use four or less
• Procedure coding to check for compliance with CCI policies, gender and age restrictions
• Medical necessity using CPT/ICD9 crosswalk data and the ordering of procedures for maximum reimbursement
• Diagnosis coding using valid primary diagnoses, proper levels of specificity and the inclusion and ordering of any required accompanying diagnoses
• Situational/conditional fields and service/procedure related fields are checked to see if they are required and reported
• Logical date-field relationships (e.g., date of onset occurs on or before date of service)
• Payor-specific published rules editing (Medicare, Medicaid, commercial carriers, etc.)
• Payor-specific unpublished rules editing