"Clinical edits" refers to the evaluation of billed codes in relationship to each other for the purpose of identifying unbundled procedures, surgical coding errors, invalid data relationships, patterns of utilization that deviate from practice standards, and diagnoses or procedures that may be invalid for the age and/or gender of the patient. Priority Health uses clinical editing software to perform its clinical edits.
Clinical edits are applied to all claims submitted by facilities or professionals, in and out of network, for all Priority Health medical plans, including Medicaid and Medicare, self-funded and fully funded.
A multi-departmental, interdisciplinary oversight committee makes decisions on whether or not to customize edits based on evidence provided in the claim documentation.
http://www.priorityhealth.com/provider/manual/billpymt/edits
The translation workplace 
peer agreement (net): +2
