In an effort to maintain an enhanced level of transparency, effective December 18, 2009, the ClaimCheck software will be upgraded from version 8.5.43.1 to version 8.5.44.

ClaimCheck is a comprehensive code-auditing tool that we use to evaluate the relationships between procedure codes submitted on the CMS-1500 form (paper or electronic formats). Claims are edited by ClaimCheck for correct coding rules and guidelines. Edits are sourced to various nationally accepted authorities, including the American Medical Association, CPT® (Current Procedural Terminology), the Centers for Medicare & Medicaid Services (CMS), and the coding and billing recommendations from national specialty societies.

Access to detailed disclosures of all ClaimCheck code edits is available through Clear Claim Connection™, which is accessible through the NaviNet® web portal 24 hours a day, 7 days a week.

This upgrade applies to all contracted providers who deliver professional services to members by way of a CMS-1500 form or equivalent electronic format. Upgrades to ClaimCheck are scheduled twice yearly, typically in the spring and fall. The release schedule for ClaimCheck upgrades is subject to modification for business reasons.

For more information about the ClaimCheck upgrade or how to access Clear Claim Connection, please contact your Network Coordinator.