Claim Editing Policies & Procedures

Overview
ClaimCheck^® software is a clinically-based procedure code auditing system licensed by CIGNA HealthCare since 1989. Beginning July 21, 2008, CIGNA HealthCare uses ClaimCheck Knowledge Base Version 41, applying the software's rules-based logic to:

• assess provider claims information, including Current Procedural Terminology (CPT^®) and Health Care Procedure Coding System (HCPCS) service codes, to detect coding irregularities, conflicts or errors;
• recommend CPT/HCPCS procedure code combinations and, when necessary, request additional claims information; and
• implement the coding guidelines, reimbursement methodologies and coverage policies of CIGNA HealthCare.

Edits
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