Provider News

Claims Editing Notification

Dear Provider,

To allow more consistent claims processing and payment, Care1st Health Plan is in the process of implementing a claims editing software, Mckesson ClaimCheck®. ClaimCheck® is a software program that assures claims are properly coded and reimbursed using industry standard coding edits. It is designed to evaluate billing information and coding accuracy on submitted claims. It is guided by the coding criteria and protocols in the CPT Manual that are published by the American Medical Association, HCPCS, National Correct Coding Initiatives, and reflective of Care1st Health Plan medical policies.

If the submitted coding does not meet current CPT standards, the software provides the most appropriate coding. It is designed to detect coding patterns, such as unbundling, integral procedures, and mutually exclusive procedures. This software is essential for keeping pace with the complex developments in medical technology and the increasingly more specific coding required today.

This software will only apply to claims billed on CMS 1500 claim form for visits, procedures, and certain ancillary services. It does not impact facility billing.

Target Production Date: December 2011

Thank you.

Care1st Health Plan
Claims Department

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