Aetna's code editing tool: No more secret edits

Why This Topic Matters

It helps readers understand that payer editing tools can be checked in advance rather than treated as hidden rules, which is important for claim preparation and administrative workflow.

Article Sections

1. Aetna’s Clear Claim Connection and claim auditing

   Introduces the payer’s web-based claim-editing tool and explains its role in displaying claim audit results before submission. It also describes the general workflow and the relationship between Aetna and McKesson’s editing platform.

2. Payer customization and transparency in editing

   Discusses how editing logic is customized by the payer and how Aetna’s approach differs from generic assumptions about bundled edits. The section emphasizes transparency and the payer’s responsibility for review of its policies.

3. Provider access, bilateral reporting preference, and claim review example

   Covers provider access to the secure tool, a sample claim review screen, and the general topic of bilateral procedure reporting preferences. It also includes the article’s example of using the tool to preview claim treatment.

4. Background on the tool’s introduction and provider response

   Summarizes the historical context for the tool’s rollout and comments from Aetna leadership about its intended benefits for physicians. It highlights the administrative and workflow goals behind the system.