Claim Editing Policies & Procedures

Overview
ClaimCheck^® is an automated code auditing tool that Cigna uses for all medical products (i.e., HMO, PPO, OAP and Indemnity) to help expedite and improve the accuracy of processing claims on a HCFA 1500 claim form. Cigna's clinical edits in the ClaimCheck^® program are based primarily on three national sources of code edits: CPT-4 guidance, Centers for Medicare and Medicaid Services (CMS) and National Correct Coding initiatives (NCCI).

Cigna updated ClaimCheck^® to Knowledge Base Version 48 and NCCI Version 17.3 Column 1/Column 2 (Incidental) and Mutually Exclusive code edits on February 20, 2012.  Cigna will then update ClaimCheck^® to Knowledge Base Version 49 and NCCI Version 18.0 Column 1/Column 2 (Incidental) and Mutually Exclusive code edits on May 21, 2012.

With ClaimCheck^®, Cigna applies the software's rules-based logic to:

• Assess Health Care Professional claims information, including Current Procedural Terminology (CPT^®) and Health Care Common Procedure Coding System (HCPCS) service codes to detect coding irregularities, conflicts or errors;
• Recommend CPT/HCPCS procedure code combinations and, when necessary, stop claims processing to obtain additional documentation;
• Implement Cigna's coding guidelines, Coverage Policies, and Reimbursement Policies; and
• Put into practice the Centers for Medicare and Medicaid Services (CMS) coding and modifier guidelines and the National Correct Coding Initiative (NCCI) Incidental and Mutually Exclusive edits.

If you are not currently registered for the Cigna for Health Care Professionals website, you can complete the registration process and log on. Go to www.cignaforhcp.com and click on the Register link located under Personalized Self-Service Websites.

For additional information, call the Customer Service Center at 1.800.88Cigna (882.4462).

Viewing Cigna Claim Coding Edits
Viewing claim code edits can be made easier with Clear Claim Connection. This disclosure tool allows you to enter CPT and HCPCS codes and immediately view the audit results. Edit Clarifications present the rationale behind a ClaimCheck edit or the definitions of NCCI edits.

Clear Claim Connection is accessible through the secure Cigna for Health Care Professionals website at www.cignaforhcp.com. Once logged on, you may review the Clear Claim Connection Frequently Asked Questions for more information.

Cigna is committed to providing solutions that can minimize your administrative costs while helping to reduce the complexity of doing business with us.

ClaimCheck Frequently Asked Questions[70k]