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Clinical Editing Tool
Clinical Editing Tool

Introduction:
Welcome to Clear Claim Connection! Using this tool, you can check our claim policies, procedure code bundling rules and other edits before filing a claim with us.

Please complete the steps below to access this tool:

Step 1: What type of service are you providing?
Chiropractic or Physical Therapy
All Other Services and Specialties
Step 2: Please select your region:
Step 3: Accept Our Terms of Use
TERMS AND CONDITIONS (CLEAR CLAIM CONNECTION)
  1. Provider acknowledges that the code auditing reference tool on the Web identifies Excellus Health Plan clinical code editing and rationale only. The tool does not identify factors that affect claim adjudication and payment, including but not limited to member benefits and eligibility, the medical necessity of the services performed, the administration of EHP's utilization management program, specific provider level agreements with EHP and the interaction of services billed on a particular claim with services previously billed and adjudicated.

  2. Provider acknowledges that use of this tool is intended for the disclosure of Excellus Health Plan Clinical Editing. Medical Policy guidelines must be followed. Use of this tool does not guarantee payment.

  3. EHP licenses a code auditing reference tool on the Web (the "Software") that enables EHP to disclose its code auditing rules and associated clinical rationale to Providers. EHP provides access to such Software to its Providers subject to the terms and conditions contained in this agreement ("Agreement"), which may be updated from time to time at EHP's or its licensors' sole discretion without notice.

  4. Provider acknowledges that the code auditing reference tool on the Web identifies Excellus Health Plan clinical code editing and rationale only. The tool does not identify subscriber's eligibility information or specific provider level agreements.

  5. Provider's right to access and use the Software is non-transferable, nonexclusive, and for the sole purpose of internal use within the United States.

  6. Provider will limit access to the Software to (i) only employees and agents of Provider and (ii) only to the extent necessary to request the outcome of specific code combinations that Provider proposes to submit to EHP regarding billing activity; and/or (iii) request information about submitted code combinations to evaluate the results of claims activity from EHP only as related to Provider's practice management.

  7. Provider shall protect the confidentiality of the information contained in and provided by the Software and that it has access to in this web site, by using at least the degree of care and security it uses to protect its own confidential information. Provider acknowledges and agrees that any unauthorized disclosure or distribution of the confidential information may result in irreparable injury to EHP or licensor(s) entitling the injured entity to obtain immediate injunctive relief in addition to any other legal remedies available.

  8. Provider shall not modify, translate, decompile, disclose, create, nor attempt to create any derivative work of the Software.

  9. Provider acknowledges that the Software is in no way intended to prescribe, designate, or limit medical care to be provided or procedures to be performed. Provider accepts responsibility for and acknowledges that it will exercise its own independent judgment in its use of the Software and shall be solely responsible for such use. Provider agrees to indemnify and hold EHP, and its affiliates, officers, agents, licensors or other partners, and employees, harmless from any claim, demand or damages, including reasonable attorneys' fees, arising out of Provider's use of the Software, or from its violation of the intellectual property rights or confidentiality obligations contained in this Agreement.

  10. Provider acknowledges that the Software incorporates the CPT terminology developed and copyrighted by the American Medical Association ("AMA") and CDT-3 and CDT-4 terminology developed and copyrighted by the American Dental Association ("ADA"). The CPT codes and terminology and the CDT-3 and CDT-4 codes and terminology are provided pursuant to licenses granted by the AMA and ADA respectively, and Provider's access to updated versions of such terminology depend on EHP or its licensor's continuing contractual relations with the AMA and ADA. AMA and ADA reserves the right to modify the CPT, CDT-3, and CDT-4 codes respectively at any time.

  11. Provider acknowledges that the Software, CPT terminology, and CDT-3 and CDT-4 terminology respectively, including all applicable rights to patents, copyrights, trademarks and trade secrets inherent therein and appurtenant thereto, is the sole and exclusive property of third parties, including Licensor, the AMA and ADA, who have licensed such rights. Provider agrees that no rights in the Software, CPT, CDT-3 or CDT-4 terminology are hereby conveyed to Provider except to the extent that Provider has the right to access and use the Software.

  12. THE SOFTWARE AND ALL MATERIALS, INFORMATION AND SERVICES AVAILABLE THROUGH IT, INCLUDING CPT, CDT-3 AND CDT-4 TERMINOLOGY, ARE PROVIDED TO PROVIDERS "AS IS", "WITH ALL FAULTS," AND "AS AVAILABLE". EHP, ITS AFFILIATES, AGENTS AND LICENSORS CANNOT AND DO NOT (i) WARRANT THE ACCURACY, COMPLETENESS, CURRENTNESS, NONINFRIGNEMENT, MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE OF THE SOFTWARE OR MATERIALS, INFORMATION AND SERVICES AVAILABLE THROUGH THE SOFTWARE OR WEBSITE, OR (ii) GUARANTEE THAT THE MATERIALS, INFORMATION OR SERVICES WILL BE ERROR-FREE, OR CONTINUOUSLY AVAILABLE, OR FREE OF VIRUSES OR OTHER HARMFUL COMPONENTS. In addition, EHP's licensors shall not by reason of Provider's access to the Software, the incorporation of the CPT, CDT-3 or CDT-4 terminology in the Software, or by any other reason, be deemed a party to this Agreement, and Provider shall look solely to EHP for the performance of any obligations due Provider hereunder.

  13. EHP has the right to modify or terminate Provider's access to the Software at any time or for any reason, including but not limited to Provider's violation of any terms of this Agreement.

  14. CPT is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable, which were, developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DEFARS 227-7202-1(a) (June 1995) and DEFARS 227-7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (1987) and FAR 52.227019 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
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