Reminder: Supporting documentation must meet criteria for consideration during audit appeals

Blue Cross Blue Shield of Michigan accepts only supporting documentation relevant to a dispute when hospitals appeal audit decisions.

Blue Cross will accept additional information during an appeal process that is “specific to the area of dispute” with “an explanation of its relevance.” Only additional information that meets both criteria will be used in evaluating the disputed adjustment of audited claims.

The additional information will be evaluated against these criteria as part of the internal appeal process. No new information can be provided at the external appeal.

Blue Cross audits hospital claims after payment to ensure accuracy and appropriateness of the claims. A claim that lacks the necessary Blue Cross supporting documentation may be adjusted. Hospitals have the right to appeal these decisions and provide supporting documentation at that time.

Please see Exhibit D of the Participating Hospital Agreement for more information about the appeals process.