ClaimCheck is an editing software program which is used by EDS Administrative
Services (EDS), the claims administrator for HealthChoice, to edit claims for
coding discrepancies.
ClaimCheck was designed by McKesson Information Solutions, a leader in claims
editing technology. This software is used to assure 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 leads ultimately to improved claim turnaround times.
ClaimCheck utilizes National Correct Coding Initiatives (CCI), Current
Procedural Terminology 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 and Medicaid Services
(CMS) 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 McKesson’s claims editing rules and clinical
rationale used in the auditing software.
Billed charges, which are edited by ClaimCheck, are not the financial
responsibility of the patient/member. In the event you disagree with any
determination made by ClaimCheck, please contact the claims administrator and
provide documented information that supports your position. Supportive
documentation should be sent to the correspondence address for the claims
administrator.
You can access ClaimCheck and Clear Claim Connection, through
ClaimLink.
