Clear Claim Connection provides claim edit information for Cigna's commercial lines of business. It is not available to view code audit results for Cigna's government business (Medicare or Medicaid) at this time.
- What is Clear Claim Connection?
Clear Claim Connection™, Cigna's code edit disclosure tool powered by Change Healthcare, allows you to enter Current Procedural Terminology (CPT®) and Health Care Procedure Coding System (HCPCS) coding scenarios and to immediately view the audit result. Clinical edit rationales, as well as edit sourcing, are provided for any code that is not allowed in Clear Claim Connection.
- Does Clear Claim Connection apply to both facility and professional claims?
Yes. Effective August 20, 2018, the Clear Claim Connection tool will support both claim form types for outpatient facility and professional services (Centers for Medicare & Medicaid (CMS) 1500 and Outpatient UB 04 claim form types). It is important that you select the correct claim form – the one that corresponds to the claim form being submitted to Cigna. Edits may differ from one claim form type to another. For Outpatient UB 04 claim forms, you are required to enter a valid Revenue Code in addition to the specific HCPCS or CPT service code.
- Should I submit an email to request claim coding information?
No. Clear Claim Connection provides the same functionality that the claim coding email provides, only with immediate results. It is not necessary to submit an email inquiry and wait for the response to receive code editing information. You can access the claim editing tool on your HCP dashboard under "Claims > View Claim Coding Edits".
- Does Clear Claim Connection contain personal health information?
No. Results provided by Clear Claim Connection do not contain personal health information.
- Does an “allow” code audit result guarantee payment?
No. Although providing access to Clear Claim Connection is meant to improve code auditing transparency, the displayed code audit results may not always reflect how claims are paid.
Many factors affect final claim payments, including a customer's specific benefit plan, the contracted health care professional or third party arrangements, and state and federal mandates.
- How do I tell which date of service range I am using?
The date range automatically defaults to the current date. If you are researching a code audit for a date outside the default range, please enter the appropriate range.
- How can I view the clinical rationales supporting code edits?
Clinical edit clarifications are available if at least one code line returns a "disallow" or "review" result. Click on the "disallow" or "review" result to view the Clinical Edit Clarification.
- What if an Invalid Procedure message appears when a CPT or HCPCS code is entered?
Assuming the code was entered correctly, new CPT and HCPCS codes that have not yet been added to ClaimsXten will display in Clear Claim Connection as an invalid procedure. This will continue until the code is added to ClaimsXten. This update is typically with the next quarterly Knowledge Base update.
- What happens if a modifier and CPT or HCPCS code that should not be used together are entered in Clear Claim Connection?
The message "Modifier XX is not valid for procedure YYYYY" will display when a modifier should not be used with the CPT or HCPCS code entered.
- What if Clear Claim Connection cannot be accessed or if an Information Alert Message appears?
Clear Claim Connection access may be disrupted for routine site maintenance on Saturdays between 8 a.m. and 12 p.m. (CST). If an alert message displays at other times or if a "Page Not Found" message displays, try the code audit search again in a few minutes.
If the Information Alert Message is numbered 200 / 208, a technical error has occurred and is preventing access. The error may be reported by calling 1.800.853.2713.
Clear Claim Connection must be accessed from the Cigna for Health Care Professional website (CignaforHCP.com). Attempting access from a bookmark will generate "Alert Message 209."
If you receive this specific error message "This user session is no longer valid," your browser history may need to be cleared. Follow the instructions found on your browser's Help menu. Once cleared, you can log back into the Clear Claim Connection form on CignaforHCP.com.
- Does Clear Claim Connection edit rationale identify any state-specific regulatory exceptions?
No, Clear Claim Connection edit rationales reflect only our national payment reimbursement policies. State-specific edits are not available through Clear Claim Connection.
- Can Clear Claim Connection be accessed using any version of Internet Explorer (IE)?
No. Effective August 18, 2018, Clear Claim Connection is no longer supported by IE9. Chrome browser or IE11 (or higher) is needed to use Clear Claim Connection.