Online Simulation Tool for Procedure Code Editing
Apex Benefits Services utilizes a professional claim procedure code editing tool, called ClaimCheck®, in the processing of claims. ClaimCheck is developed by McKesson Health Solutions LLC, and licensed, adopted and modified by Apex Benefits Services to assist in consistent claim reviews. The types of billing problems that are audited include, but are not limited to, unbundling, mutually exclusive services, duplicate submissions, fragmented billing of pre- and post-operative care, age/sex mismatch, upcoding, as well as obsolete, or invalid codes. Providers can simulate probable procedure code editing rules for Apex Benefits Services claims prior to submitting a claim or after receiving the EOP. Apex Benefits Services has made this online editing simulation tool, called Clear Claim Connection, available to participating providers.
Log into Clear Claim Connection.