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Code Auditing Reference Tool (CMS-1500 Claims)



For CMS-1500 claims, Harvard Pilgrim's offers the Code Auditing Reference Tool, a Web-based software application designed to enable providers to gain a better understanding of code auditing rules including, but not limited to, incidental procedures, mutually exclusive procedures, bundling/unbundling procedures and codes in conflict with age/gender. The Code Auditing Reference Tool can increase your administrative efficiency by reducing manual inquiries, claim appeals, and misunderstandings regarding claim edits. Providers and their office staff registered with HPHConnect can review the claim payment methodology and reimbursement policies behind coding edits. To access Harvard Pilgrim's Code Auditing Reference Tool, please login into HPHConnect.  Not an HPHConnect user? Register now! 

If you have questions or would like more information, please contact the Provider Service Center at
(800) 708-4414.

 
Key Contacts
Provider Service Center
(800) 708-4414
Referral & Authorization Requests
(800) 708-4414
Behavioral Health Care Resources
(888) 777-4742
Care Management
(888) 888-4742,
Ext. 31035
EDI Team
(800) 708-4414 (Option 1; then press 3)
HPHConnect
(800) 708-4414
(Option 1; then
press 6)
Provider Relations Consultants (PRC)
  • CT
    (877) 594-7190
  • MA/RI
    (888) 888-4742
  • ME
    (888) 476-2463
  • NH
    (800) 544-9759

Who's my Provider Relations Consultant?
Key Contacts Directory (Download)