ClaimCheck and Clear Claim Connection

ClaimCheck is an editing software program which is used by HP Administrative Services, LLC. (HP), 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.