Compass Code Edits systematizes the technology applied to code validation use on claims that has too often been left for manual review by medical professionals. Beacon has designed Compass to analyze all incoming claims for compliance and accuracy from a medical billing and coding appropriateness standpoint. The system flags claims that attempt to bill incompatible or unnecessary procedures by performing checks for medically unlikely or unnecessary combinations of events or codes, along with a host of other checks for reasonableness.
Controls are available for users to design and implement procedures within your smart workflow queues to automatically pend or deny claims flagged by Compass to the appropriate department for review. Compass increases end-to-end efficiency by allowing you to spend less time on manual review. Enhance your claims adjudication process with Compass by adding increased accuracy and appropriateness checks for claims.
- Identification of services that may have unnecessary, inappropriate, or incompatible codes
- Validation for expired or non-existent codes
- Automatically deny or pend claims to user-defined, smart workflow queues
- Ability to reduce unnecessary medical costs
- Automate code edits without the need of manual review by medical professionals
- Dramatically increase savings on affected claims
- Improve auto-adjudication rates and claim payment accuracy
How Does it Work?
Hover over the graphic below for an interactive look at the functionality of Compass Code Edits.
Code Edit Validation Checks
|Ambulatory Surgical Center (ASC)||Procedure to Procedure (PTP)|
|Add-on Codes||Medically Unlikely Edit (MUE)|
|Diagnosis & Age Conflict||Procedure & Age Conflict|
|Invalid Procedure for Assistant Surgeon||Procedure & Gender Conflict|
|Invalid Procedure for Co-Surgeon||Bundled Procedures (B Codes)|
|Diagnosis & Gender Conflict||Incidental Procedures (T Codes)|
|Global Surgery Edit (GSE)||Terminated Diagnosis Codes|
|Invalid Diagnosis Code||Terminated Procedure Codes|