Payment and Policy Commercial Insurers
Administrative burden, utilization management, "front-end claims edits," and more: the commercial payer landscape continues to shift.
Front-end claim edits are on the rise
Front-end edits—when a payer automatically denies a claim with a certain profile, forcing the provider to appeal the denial and provide documentation supporting the appeal—are being implemented by several payers and third-party administrators. For PTs, the most frequent trigger for a front-end edit is the use of the 59
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