Reader Questions:
Unravel the 'Different Edits'Mystery
Published on Fri Apr 18, 2008
Question: I follow Correct Coding Initiative (CCI) edits, but some carriers don't follow these guidelines. Why not? Virginia SubscriberAnswer: You're right. Some carriers follow CCI edits, but some don't. Those that don't, instead follow McKesson edits. McKesson is a clinical editing system that you cannot access.For instance, Aetna follows McKesson edits and will not bend on this. CIGNA does as well, but you may obtain reimbursement after a review. You may have success with Blue Cross Blue Shield (BCBS) depending on whom you talk to.However, other carriers like UnitedHealthCare do not follow McKesson edits altogether.