Clear Claim ConnectionTM is a web-based, code-auditing reference tool designed to mirror how Claim Check® evaluates code combinations during the auditing of professional claims. Clear Claim ConnectionTM enables AmeriHealth to disclose its claim auditing rules and clinical rationale inherent to the Claim Check® system. Through this tool, you can view the justifications and clinical rationale on why code combination logic was applied to a professional claim processed in the base claims processing system.
The Significant Edits Disclosure Report is a searchable list of ClaimCheck® Significant Edits. A Significant Edit is defined by IBC as any ClaimCheck edit that results in the denial or reduction in payment for a particular CPT Code or HCPCS Level II Code more than 2000 times a year. This report will be updated annually.
Clear Claim Connection User’s Guide
