P-ACE Smart Edits Information

The Palmetto GBA Advanced Clinical Editing System (P-ACE) returns pre-adjudicated Jurisdiction 11 Part B claims information through claim acknowledgement transaction reports based on the Medicare 277CA. All direct submitters will receive the Medicare 277CA report with the new smart edits if a claim is identified as containing a potential Smart Edit error. Claims failing the pre-adjudication editing process are not forwarded to the claims adjudication system. This give you an opportunity to review and update your claim prior to submission for processing. However, if you choose not to change the claim after you have reviewed the Smart Edit, you can resubmit your claim in its original format and the claim will be forwarded to the MCS claims adjudication system for processing.