Code Edits

Clear Claim Connection is a web-based tool by McKesson Health Solutions that lets providers review PEHP’s claim auditing rules and the clinical rationale behind them. It offers easy access to claims payment policies, related rules, and clinical edit clarifications. To use the tool:

1. Log in to the PEHP Provider Portal.
   2. Select Clear Claim Connection (agreement to terms & conditions required).
   3. Enter claim details (up to four modifiers, four diagnosis codes, and 10 procedure codes).
   4. Click Review Claim Audit Results to see if codes are allowed or disallowed.

For disallowed codes, click Review Clinical Edit Clarification to see PEHP’s rationale. If you disagree, you can submit a written appeal.

Benefits of Clear Claim Connection:

• Reduces administrative costs and front-line calls
• Fewer provider appeals and claim reprocessing
• Easy to use with immediate responses
• Available 24/7 for pre-screening claims or reviewing denials
• Ensures consistent communication with providers

If you haven't signed an Electronic Trading Partner Agreement (ETPA), you can download the entire document and send it to us via email: providersubmissions@pehp.org.