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February 2018

Don’t resubmit professional and ancillary claims involved in audits

Blue Cross Blue Shield of Michigan is reminding providers not to resubmit any professional or ancillary claims involved in our audits. These include the following types of providers:

  • M.D.s, D.O.s and specialist physicians
  • Ambulance providers
  • Certified registered nurse anesthetists
  • DME/P&O
  • Home infusion therapy
  • Independent labs
  • Independent physical therapy and occupational therapy
  • Licensed psychologists
  • Nurses
  • Ophthalmology
  • Oral surgery
  • Pharmacy
  • Podiatry
  • Provider office infusion therapy
  • Rheumatology
  • Urgent care

Once you receive a letter and patient list notifying you of an audit and the claims that will be part of the review, these claims can no longer be adjusted even after the audit has concluded. Be sure to let your billing and finance departments know which claims are being audited so they won’t resubmit any claims until Blue Cross notifies them to do so.

Rebilling charges is time-consuming and can create additional problems once the audit process is complete and claims are submitted for adjustment.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.