Do not resubmit claims involved in audits

Blue Cross Blue Shield of Michigan is asking providers not to resubmit claims that are involved in our audits. This includes any inpatient or outpatient facility audits including:

• Readmissions
• Diagnosis related group
• Catastrophic cost outliers
• Transfers
• Focus
• Emergency room
• High dollar
• Hospital physical therapy, occupational therapy and speech language pathology
• Ambulatory surgery facility
• Freestanding outpatient physical therapy facilities
• End stage renal disease
• Skilled nursing facility
• Home health care
• Hospice

Once you receive a letter notifying you of an audit, including a patient listing, don’t adjust these claims any further. Please let your billing and finance departments know which claims are being audited so they won’t submit any further claims unless you’re notified by the Blues to do so.

Catastrophic cost outlier claims have an additional exception; please see the article in the December 2011 Record. These claims can only have charges rebilled up to 30 days prior to the audit.

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

For more information, please contact your provider consultant.