About
About ClaimEdits
ClaimEdits (claimedits.com) explains why a claim edit fired — the NCCI and payer medical-policy logic behind a denial — before the claim goes out. It is published by PayerParity, an independent healthcare reimbursement analytics practice.
Who builds it
ClaimEdits is built by people who configured claim-editing logic inside payer systems — the NCCI edits, the MUE limits, and the custom medical-policy rules that decide whether a line pays or denies.
- 20 yrs
- inside core payer administration and reimbursement design
- 15+
- national health plans advised on contract modeling and platform architecture
- 10,000+
- payer–provider agreements implemented, validated, and corrected
- 1.7M+
- NCCI edits, MUE limits, and custom clinical edits in production
That background is why this site can explain why an edit fired, not just thatit did — the PTP relationship, the modifier that does or doesn't break it, the MUE rationale — the same logic these edits run under in production adjudication.
What this site covers
- Edit lookup — search a code pair and see which edit applies and why.
- Rationale — the published basis for the edit, in plain language.
- Modifier guidance — when an override is and is not appropriate.
Who it is for
Billing and revenue-cycle staff, coders and coding auditors, claims and configuration analysts at health plans, and clinic managers reconciling denials. The site is free to use and requires no account.
Independence
ClaimEditsis an independent reference. It is not affiliated with, endorsed by, or sponsored by the Centers for Medicare & Medicaid Services, any health plan, or any government agency, and it is not a substitute for official guidance or for adjudication by a payer. Content derives from publicly published sources, including NCCI edits and payer medical policy.
Contact
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