Code Auditing
CDPHP Uses ClaimCheck® Software
CDPHP applies code auditing to medical claims using McKesson Health Solutions LLC ClaimCheck® software.
ClaimCheck® is a clinically based, expert software system that evaluates claim information. A knowledge base—which includes a comprehensive set of data and rules—functions in conjunction with the software to assist users in automating correct coding and medical policy decisions and to detect coding irregularities, conflicts, or errors, making recommendations for correction.
ClaimCheck® uses clinically-based rules logic to:
- Assess provider claims information including CPT®/HCPCS procedure codes against a series of edit programs.
- Recommend CPT®/HCPCS procedure codes and request additional claims information, when necessary.
- ClaimCheck® contains customization capabilities that allow each customer to reflect the payor's unique coding guidelines, reimbursement methodologies, and medical policy.
Refer to CDPHP Resource Coordination Policy 1370/20.000437; Code Auditing Customization, for custom edits.
Specific coverage is always subject to the member's eligibility, contract benefits, and CDPHP medical policy.
Please contact the provider services department with any questions at (518) 641-3500 or 1-800-926-7526.
The above is printed with permission of McKesson Health Solutions, LLC.