April 18, 2019
The Claims Editor ‘What If’ tool helps providers test combinations of procedure codes and circumstances that will be entered on a professional claim. Entering code combinations into this tool can identify if codes will encounter an edit when the claim is formally submitted.
This tool is based on the information submitted at that time and isn't a guarantee of payment. It doesn’t consider information such as claims history, member eligibility or benefits, provider reimbursement calculations or provider contract terms, or member and group specific information.
The Claims Editor ‘What If’ tool receives updates eight times a year that include additions, deletions and revisions to CPT codes, HCPCS codes, ICD-10 CM Diagnosis codes, and ICD-10 PCS procedure codes. In addition, quarterly updates and revisions to National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUE) edits as released by CMS are also current.
Access the Claims Editor ‘What If’ tool on the secure provider website:
- Click on ‘Tools’ in the left navigation menu and then ‘Claims Editor’.
- Sign in to your One Health Port account. The claims entry screen for the Claims Editor ‘What If’ tool will appear.
- Fill in the designated claims information and ‘Submit.’
- If your claim information encounters an edit, the response will be highlighted in red type.
This tool can be used for past and future dates of service. Currently, the edits encountered are applicable to professional claims only.