Commercial professional and facility claim audits begin April 1

HMS^® and SCIO Health Analytics^®, independent companies working for Blue Cross Blue Shield of Michigan, will assist with auditing claims for all commercial professional and facility services, starting April 1, 2018.

The scope of the audits will be either claim-specific or project-based, and will ensure that billed and paid services were ordered, medically necessary, documented, reported and covered under the patient’s contract, according to Blue Cross’ policies and guidelines. This applies to all providers who bill procedure or revenue codes.

The audits will look back two years and confirm that you’ve properly billed and documented requirements for services billed.

Be ready to share medical charts for review. After an audit, HMS or SCIO will send the findings and information on how you can ask for an appeal, if necessary.

The purpose of provider audits is to:

• Confirm compliance with HCPCS and CPT codes that are in effect on the date of service.
• Ensure services billed are medically necessary.
• Detect, prevent and correct waste and abuse.
• Facilitate accurate claim payment.

Questions?

Contact your provider consultant. During an audit, call 1-866-875-1749 to speak with an HMS representative, or 1-866-628-3488 to speak with an SCIO representative.