Disclosing Claims Payment Rationale

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Transparency and disclosure are more than just buzzwords — they are necessary elements as you strive to build trust with your providers. With Clear Claim Connection™, our web-based code audit disclosure solution, you can disclose your claims payment policies, rules and edit rationales directly to your provider networks.

Clear Claim Connection is available for ClaimCheck®, our comprehensive code auditing solution, and ClaimsXten™, our solution for implementing and managing claims payment policies.

With Clear Claim Connection, physicians can access your audit rules, edit rationales and associated clinical logic via your Web portal, increasing transparency and also helping you educate your provider communities on your edits and medical payment policies. You can monitor access through Clear Claim Connection's flexible reports.


  • Provides rationale for each edit
  • Provides policy and editing logic to improve physician coding
  • Reduces administrative costs
  • Increases first-pass adjudication rate as providers improve coding practices
  • Reduces the frequency, effort and cost of manual inquiries and appeals
  • Increases productivity due to greater automation of your front-end claims adjudication and your back-end customer service processes
  • Gives your staff and providers 24x7 access to medical policy and edit information