US · guidance
CMS Pub. 100-08, ch. 7, § 7.2.2.15
Medical Review Edit Development
Medical Review edit development includes all activities necessary to create and set up a
computerized logic test developed with the assistance of health professionals that
compares the data elements on a Medicare claim for the purposes of: (1) making a local
coverage or coding determination; or (2) suspending a claim so such determinations can
be made by appropriate Medical Review personnel prior to or after payment of the claim.
History
(Rev. 642, Issued: 02-22-16, Effective: 02-16-16, Implementation: 02-16-16)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
221585307dff330e05c57fb651e1d2f617cbb0e1c920a5771ee588b19de0537c
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