Medicare Smart Edits

In an attempt to assist providers in ensuring their claims are submitted cleanly and processed without delay, CMS and associated MACs are rolling out a series of Smart Edits. The idea is to identify the error more quickly so it can be corrected and sent back before receiving a denial.


The first of which is to begin on July 15, 2023, and will include payer IDs.


This article from Medicare MAC Novitas, explains in additional detail how smart edits will work, including a roll-out schedule.

This article, also from Medicare MAC Novitas, details some of the new denial codes you will begin seeing. These claims will be visible in your Live Claims Feed under Claim Status. Working these claims daily, correcting any errors, and resubmitting will keep your claims moving and limit delays in processing for the identified issue.


Update July 31, 2023 - additional smart edits will be added. Here is an updated list.


If your practice location utilizes a different Medicare MAC than Novitas, please refer to their website for their specific rollout schedule.