Medical Review Edit Development

7.2.2.15 - Medical Review Edit Development (Rev. 642, Issued: 02-22-16, Effective: 02-16-16, Implementation: 02-16-16) 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.