Claim Editing Policies & Procedures

• Overview
• Edits

Overview

ClaimCheck® software is a clinically-based procedure code auditing system, in use at CIGNA HealthCare since 1989. CIGNA HealthCare currently licenses ClaimCheck software Version 37.

Claim auditing software uses rules-based logic to:

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

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Edits

To view claim bundling edits, you must log into or register for CIGNA for Health Care Professionals.

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