EncoderPro.com for Payers

• Optum360 CodeLogic^TM search engine. Find and validate CPT^®, HCPCS, ICD-9-CM and ICD-10-CM/PCS 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/PCS. Includes mapping content from ICD-9-CM v1 v2, and v3 codes to ICD-10-CM and -PCS codes (as well as backward mapping) using the GEM (General Equivalency Mappings) and Optum360 MapSelects clinical mapping content. Also includes ICD-10-CM and -PCS searching and Optum360 tabular (ICD-10-CM and -PCS books) content.
• Enhanced compliance editor with the Optum360 ClaimsManager rules. Check claim compliance for selected codes through an edit check to ensure proper unbundling, correct modifiers, complete diagnoses, and more prior to submittal to a clearinghouse/vendor/payer. Includes an 24-month historical content database for use during claim adjudication. Over 130 coding rules are reviewed.
• Featured Coders’ Desk Reference lay descriptions. Clearly understand CPT^®, HCPCS, ICD-9-CM and ICD-10-CM/PCS 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.
• Local coverage determinations (LCDs) and Medicare’s Pub. 100 access. Check procedures for Medicare coverage instructions and medical necessity edits across all CMS MACs. Understand which ICD-9-CM (and ICD-10-CM) procedures define medical necessity and what the documentation guidelines are for successful claim submission. Gain insight into procedures and services that carry little or discretionary coverage and how to report them.
• Medicare secondary payer coordination of benefits. Access the entire MSP Manual and understand assigning responsibility for first and second payer.
• Notepad. Store your most frequently used codes for easy access and export your codes to Windows programs.

• AHA Coding Clinic^® for HCPCS Add-on (Items WA03 & WA03C)
• AHA Coding Clinic^® for ICD Add-on (Items WA02 & WA02C)
• The AMA CPT^® Content Module Add-on (Item WA34)
• Total CPT^® Add-on (Item WA37)
• The ASA CROSSWALK^® Add-on (Item WA24)
• Claim Appeal and Denial Support Add-on (Item WA32)
• Clinical Documentation Improvement Add-on (Item WA35)
• Coders' Dictionary Add-on (Item WA05)
• Dental Codes Add-on (Item WA23)
• Dr. Z’s Medical Coding Series: Interventional Radiology Add-on (Items WA30 & WA31)
• DrugReimbursement.com Add-on (Item WA08)
• EncoderPro.com Plus Add-on (Item WA45)
• Historical Application Content Add-on (Item WA11)  
• Optum360 Specialty Articles Add-on (Item WA22)

 CPT is a registered trademark of the American Medical Association.