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Clear Claim ConnectionTM

Claims processed on the legacy platform (i.e., before member was migrated)

Clinical Relationship Logic for claims submitted on the CMS-1500 claim form or through the 837P transaction will continue to have ClaimCheck® edits applied. These edits are disclosed through the existing Clear Claim ConnectionTM tool, which is available through the NaviNet® web portal at www.navinet.net. You can also log in using the link to the right.

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 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 for non-migrated members that was processed on the legacy 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 health care 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‚Äôs 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