Last Updated: August 20, 2008

MetroPlus to Implement Claims Auditing Software

MetroPlus Health Plan will implement a claims auditing software program on or about September 15, 2008. The software, ClaimCheck®, compares submitted claims to standard American Medical Association (AMA) CPT® coding and CMS approved NCCI (National Correct Coding Initiatives) guidelines. If the submitted coding does not meet current CPT /NCCI standards, the software provides the most appropriate coding. ClaimCheck is designed to detect coding discrepancies automatically. Automated reviews are more efficient, resulting in lower administrative costs; faster claims turn around time, more consistency, and a fairer adjudication of claims. Most importantly, ClaimCheck is a valuable tool we can use together to improve the value of claims data to foster continuous health care quality improvement.

Annual Provider Satisfaction Survey

Our annual Provider Satisfaction Survey will be mailed out in mid-July 2008. Please do not forget to complete the survey and mail it back to our survey administrator, The Myers Group, in the enclosed postage paid envelope. If you have any questions regarding the survey, please call 1-877-901-8432. Your feedback is extremely important to us and greatly appreciated. We thank you in advance for working with us to improve the health of MetroPlus Health Plan members.