Comprehensive Code Auditing

ClaimCheck™ is our comprehensive code auditing solution that helps you manage your medical benefit dollars and lower administrative costs through accurate, consistent and timely reimbursements per your payment policies.

ClaimCheck applies expert edits from our industry- and provider-recognized knowledge base to analyze claims for accuracy and applicability to your payment policies. ClaimCheck can be customized to meet your unique medical policy needs. With our regular knowledge base updates, you always have the most current code editing content.

ClaimCheck delivers significant benefit dollar savings and operational efficiencies helping to increase productivity and auto-adjudication rates. Every health plan has unique criteria, and we would be happy to apply our ClaimCheck Value Calculator to estimate the potential value you could achieve through more automated, more accurate reimbursements enabled by ClaimCheck.


  • Pay claims accurately
  • Reduce administrative costs
  • Manage medical loss ratio
  • Decrease claims suspensions while increasing productivity


ClaimCheck automatically addresses coding issues:
  • Identifies billed services that may have used incorrect codes, and provides the reasons for denial, based on your medical policies.
  • Recommends fixes for incorrect procedure codes on professional and outpatient facility claims based on Correct Coding Initiative (CCI) guidelines.
  • Flags procedure submissions that may require additional documentation or review.

Built on a solid clinical foundation-ClaimCheck applies the McKesson expert clinical Knowledge Based, developed and maintained by our team of full-time physicians, registered nurses, coding experts and other healthcare professionals. This team's diligent research and analyses helps to deliver highest quality clinical content and documentation to support the clinical logic of McKesson code auditing solutions.

The ClaimCheck knowledge base incorporates guidelines from industry-standard and essential clinical coding sources, including:
  • Current Procedural Terminology (CPT®)
  • Healthcare Common Procedure Coding System (HCPCS)
  • International Classification of Diseases Clinical Modification (ICD-CM)
  • American Medical Association (AMA) and Centers for Medicare and Medicaid Services (CMS) guidelines
  • Specialty society guidelines
  • Medical policy and literature research and standards
  • Input from academic affiliations

Customers can reference the McKesson clinical logic through Clinical Inquirer on our McKesson client Web site. This rich source of valuable information is available to customers 24 hours a day.

Configurable-To meet your unique contractual and medical policy needs, ClaimCheck offers the following:

  • SmartSuspense™: This feature allows you to easily define and configure custom edits to audit by physician, specialty, member, procedure code, modifiers and other user-defined fields. You can set auditing results to flag, monitor or deny.
  • MultiAccount: This feature allows you to define and store multiple customization files. Each of your accounts can have its own unique edits while sharing a single, core generic database.
  • Onsite customization: You can customize both the software and database in a variety of ways, with changes preserved from release to release without repeating data entry.


An add-on module to ClaimCheck, ClaimReview delivers a customizable second level of review for claims that usually require manual processing.