Line Item Validation

Want to check your coding before export? Use the Line Item Validation feature in Claim Maker.

• To access Validation, make sure you are in the Coder View.
• Select the Validation tab and click Validate (see image below).
• Coding updates (if any) are recommended based on the validation results.

What validation checks

Validation runs the coded line items through the HANK validation service. Its checks include:

• Code validity: CPT codes, ICD-10 codes, and modifiers are valid and active for the date of service.
• NCCI procedure-to-procedure edits: code pairs that Medicare's National Correct Coding Initiative bundles together.
• Medically Unlikely Edits: units of service above the NCCI limit for a code.
• Physician Fee Schedule rules: fee schedule indicators for the billed codes.
• Coverage determinations: national and local Medicare coverage policies (NCD/LCD) for the code and diagnosis combination.
• Anesthesia crosswalk: the anesthesia code agrees with the documented surgical procedure.
• Rare-pattern checks: code and diagnosis combinations that almost never appear together in practice.

Which checks run can vary by organization.