{"id":14,"date":"2025-09-11T14:13:35","date_gmt":"2025-09-11T14:13:35","guid":{"rendered":"https:\/\/www.norejects.com\/services\/"},"modified":"2026-02-17T13:40:03","modified_gmt":"2026-02-17T18:40:03","slug":"services","status":"publish","type":"page","link":"https:\/\/www.norejects.com\/?page_id=14","title":{"rendered":"Pre and Post Edits Service"},"content":{"rendered":"

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\n Pre and Post Edits Service
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\n Optimize your PPE workflow with intuitive tools. Access resources, verify margins, automate edits, and streamline complex combinations efficiently.
\n Explore our PPE portal with streamlined navigation and easy access to all your resources.\n <\/p>\n<\/p><\/div>\n

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Margin Verification<\/h3>\n

\n Verify claim is profitable, adjust pricing if needed, or reject if necessary. Margin Verification ensures your claims remain accurate and profitable throughout processing.\n <\/p>\n

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  • Desired Markup + Fee<\/li>\n
  • Max allowable loss<\/li>\n
  • U&C Adjustments returned to PIS or as alert<\/li>\n<\/ul>\n
    \n

    Example Reject:<\/strong><\/p>\n

    NR1> Below cost reimbursement.  \nClaim paid and reversed at $103.25.  \nOriginal response: Humalog preferred<\/pre>\n<\/p><\/div>\n<\/p><\/div>\n
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    Standard Edits<\/h3>\n
    \n        Validate correctness and coding for all claims and ensure compliance by filling in missing information automatically.\n      <\/p>\n
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    • M\/I DAW not specified<\/li>\n
    • M\/I Quantity (not multiple of UoU Pack-size)<\/li>\n
    • Update AWP to current<\/li>\n
    • Default missing fields:\n
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      • Pharmacy class of service<\/li>\n
      • COVID\/Flu Diagnosis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n
        \n
        Example Reject:<\/strong><\/p>\n
        NR1> Multi-source brand has generics available.  \nSubstitute to generic or add appropriate DAW.<\/pre>\n<\/p><\/div>\n<\/p><\/div>\n
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        Combo Enablement<\/h3>\n
        \n        Simplify complex billing combinations and ensure correct facility-level information for long-term care and multi-site claims.\n      <\/p>\n
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        • Match Patient Residence Code or Facility Name field<\/li>\n
        • Replace Retail NPI with LTC NPI<\/li>\n<\/ul><\/div>\n
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          Vaccine Coding<\/h3>\n
          \n        Automate accurate vaccine coding, reduce rejections, and ensure complete submissions across all vaccine claims.\n      <\/p>\n
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          • Match Flu Vaccine<\/li>\n
          • Where missing, add:\n
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            • Diagnosis Code<\/li>\n
            • Professional Service Code<\/li>\n
            • Incentive Amount Submitted<\/li>\n<\/ul>\n<\/li>\n
            • Optionally:\n
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              • Check IIS administration history \/ report dose<\/li>\n
              • Auto-handle certain rejects<\/li>\n<\/ul>\n<\/li>\n
              • For other vaccines, dose number can be automatically calculated and added.<\/li>\n<\/ul><\/div>\n<\/p><\/div>\n
                  <\/p>\n
                \n    \"No\n  <\/div>\n<\/section>\n
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