Two recent Web site enhancements allow registered providers to:
- Determine how your claim will be adjudicated
- Review historical claims
The Enhancements
Clear Claim Connection (C3), available through Provider Connection on optimahealth.com and MDoffice, allows you to input currently utilized CPT code combinations and determine how the Code Review claims editing software bundles or otherwise modifies the codes billed, including rationale and source documentation. Please be advised that C3 does not currently allow for review of whether diagnosis and CPT code combinations match appropriately.
Historical Claims Auditing (HCA) is an enhancement to the current bundling/unbundling software Code Review which will begin looking back at historical claims processed for the same member and will expand the claims review with the following:
- Review pre-op and post-op E&M codes. HCA will audit the member’s history for E&M codes billed during the global period.
- Review the member’s history for claims received from the same vendor, for the same date of service and for the same diagnosis.
- Review multiple surgeries and automatically apply multiple surgery reductions based on the procedure with the highest work RVU.
- Review the quantity being billed for the service.
System Requirements
There are a few minimum system requirements necessary to access these tools:
1) Internet Explorer 6.0 or above
2) Default settings enabled
Other Questions
If you have any questions about the software noted above, contact Provider Relations.