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Clear Claim ConnectionTM and Significant Edits Disclosure Report

Clear Claim ConnectionTM

Clear Claim ConnectionTM is a web-based code auditing reference tool designed to mirror how ClaimCheck® evaluates code combinations during the auditing of professional claims. Clear Claim ConnectionTM enables Independence Blue Cross (Independence) to disclose its claim auditing rules and clinical rationale inherent to the ClaimCheck® 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.

Claim Check® and Clear Claim ConnectionTM are updated regularly for consistency with Company Medical and Claim Payment Policy, new procedure codes, current healthcare trends, and/or medical and technological advances. Claim Check® clinical relationship logic is applied based on the date a claim is processed, reprocessed or adjusted in the company’s claims processing system. Clinical relationship logic is not applied based on the date the service was performed. Therefore, claims that are reprocessed or adjusted for any reason may receive a different editing outcome from Claim Check® based on the clinical relationship logic that is in effect at the time the claim adjustment occurs.

Notwithstanding the foregoing, it is understood that a specific Claim Payment Policy may supercede the terms of this policy with respect to the subject of that Claim Payment Policy only.

Clear Claim Connection User’s Guide

Significant Edits Disclosure Report

The Significant Edits Disclosure Report is a searchable list of ClaimCheck® Significant Edits. A Significant Edit is defined by Independence 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.