Pattern Detection Smart Edits

Published 03/13/2023

Palmetto GBA uses data-driven pattern detection techniques communicated through 'smart edits'. These will appear on claim rejection reports as Palmetto GBA/Railroad Medicare deploys 'ACE' to the electronic claim submission process for professional claims. 'ACE', an abbreviation for 'Advanced Communication Engine', returns pre-adjudicated messaging through claim acknowledgement transaction reports sent by your clearinghouse based on the Medicare 277CA. These pattern detection Smart Edits assist providers in monitoring specific billing patterns and can serve as a great aid providing detailed provider education for auditing purposes.

A key component of this proactive strategy involves enabling your staff to use the pattern detection smart edits to identify problem areas using this internal auditing tool. ACE requires no downloads or required software and is available at no cost to you. ACE can integrate with whatever clearinghouse you currently use, achieving a more streamlined claims processing transaction between your healthcare facility and Medicare. This approach to claims processing is being modernized to better serve our provider community and address the complex claims edits you deal with every day. We continually explore ways to transform our claims system to be more responsive through new processes and technology, because helping you submit 'clean' claims is our priority.

Please visit the EDI Tools for more information on ACE Smart Edits.

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