ClaimCheck and Clear Claim Connection
ClaimCheck and Clear Claim Connection are claim processing software programs used to ensure claims are properly coded using industry-standard coding edits.
ClaimCheck is designed to detect coding discrepancies automatically. Automated reviews improve accuracy and consistency in claims adjudication and lead to improved claim turnaround times. ClaimCheck utilizes National Correct Coding Initiative (CCI), Current Procedural Terminology (CPT) guidelines as published by the American Medical Association, and the general standards of medical practice in editing claims. Editing guidelines established by the Centers for Medicare & Medicaid Services are also included in ClaimCheck rules.
Clear Claim Connection provides specific, detailed information regarding ClaimCheck’s procedure code auditing software and how it evaluates code combinations during the processing of a claim. Clear Claim Connection allows the HealthChoice Network Provider online access to claims editing rules and clinical rationale used in the auditing software.
You can access ClaimCheck and Clear Claim Connection through ClaimLink. HealthChoice encourages its Network Providers to utilize this website function to reference the Clear Claim Connection feature of the claims editing system.
In the event you disagree with any determination executed by ClaimCheck, please contact the medical and dental claims administrator. You will need to provide any documented information that supports your position.