May 4, 2017
Use the Claims Editor/What If tool to identify possible claim edits before submitting your claim. This helps produce cleaner claims and reduce payment delays.
The tool allows you to test billing scenarios and code combinations against our claim editing software. Before you submit your claim, you'll know if you're likely to encounter an edit. The tool helps you identify modifier combinations, codes that bundle, and more. The tool is located on Premera's secure provider website which requires a OneHealthPort (OHP) user ID and password.
How to access the tool:
- Go to the provider landing page.
- Click on the Claims Editor, located in the left blue sidebar under tools. (You'll be asked to sign in using your OHP user ID and password if you aren't already signed in.)
- Enter the following information: patient's gender, date of birth, place of service, diagnosis type, and diagnosis codes.
- Choose 'submit claim inquiry' and we'll give you a summary of possible edits, along with a link to 'see full explanation' of the edits if you want more information.
We update the tool regularly for maintenance and code updates so the information is always current. Visit our Claims Editor/What If Tool user guide for more information and sample screen shots.
Disclaimer: The Claims Editor/What If tool does not apply member benefits, eligibility, or provider contracting or reimbursement information and it is not a guarantee of payment.