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EncoderPro.com for Payers provides online access to comprehensive code validation software for fast search capability. Designed specifically for payer organizations, users can search for CPT® procedures, HCPCS Level II supplies and services, and ICD-9-CM diagnosis and procedures codes based on descriptions on the provider and hospital claim forms. Plus, with EncoderPro.com for Payers, users can correctly identify the services in question for outpatient and inpatient hospital services, invasive procedures, CT, MRI, and PET scans.
Key Features and Benefits
· Optum CodeLogicTM search engine. Find and validate CPT®, HCPCS, and ICD-9-CM codes using lay terms, acronyms, abbreviations, and even the misspelled words found on outpatient and inpatient UB-04s and providers’ CMS-1500 claim forms.
· ICD-10-CM – Includes ICD9 v1 and v2 codes mapped to ICD10-CM codes using the GEM (General Equivalency Mappings) and Ingenix clinical content. Also includes Ingenix Tabular (ICD10-CM book) Content and Ingenix mapping logic.
· 2012 edition will include ICD-10-PCS mapping to ICD9 v3 codes (both GEM and OptumInsight mappings) as well as ICD-10-PCS index and “build-a-code” feature.
· Featured Coders’ Desk Reference lay descriptions. Clearly understand CPT®, HCPCS, and ICD-9-CM codes using Coders’ Desk Reference lay descriptions—a one-stop resource, providing lay descriptions for surgical, laboratory/pathology, radiology, and medicine codes, eliminating the need for multiple resources and increasing productivity.
· Color-coded edits. Determine charges allowed by Medicare for capitation, fee-for-service, outpatient and inpatient hospital services, and provider payments. Know cost and reimbursement amounts by understanding whether a code carries an age or sex edit, is covered by Medicare, or contains bundled services.
· Medicare secondary payer coordination of benefits. Access the entire MSP Manual and understand assigning responsibility for first and second payer.
CPT® is a registered trademark of the American Medical Association.
