The TRICARE South Region uses ClaimCheck® to review claims on a prepayment basis. ClaimCheck® is an automated product that contains specific auditing logic designed to evaluate provider billing for CPT coding appropriateness and to eliminate overpayment on professional and outpatient hospital service claims.  Humana Military updates ClaimCheck® periodically with new coding based on current industry standards.
 
Humana Military utilizes Claim Review, an automated module in ClaimCheck® designed to check claims for consistency, intensity of service, and revisit frequency through the codes specified. To avoid unnecessary claim line rejects, be sure to assign a diagnosis code that represents the reason the procedure is performed, as well as any diagnosis that will impact the treatment.