BCBSM/BCN Dual Header The Record Header Logo

The Record - Insurance Card with the BCBSM/BCN Cross and Shield logo that reads, Blue Cross Blue Shield, Blue Care Network of Michigan. Tagline: Confidence comes with every card. Image of Note boards with paper that has the letters RX on it accompanied by a stethoscope

Forward to a friend  |  Subscribe  |  The Record Archive  |  Contacts  |  bcbsm.com  |  Print this article
December 2017

Reminder: Don’t resubmit claims involved in audits

Blue Cross Blue Shield of Michigan requests that you not resubmit inpatient or outpatient facility claims that are already part of an audit. Why? It’s time consuming to rebill charges. And it can create more problems once the audit process is complete and we send the claims for adjustment.

Once you receive a patient listing with an audit notice letter:

  • Don’t adjust the related claims any further.
  • Let your billing and finance departments know which claims we’re auditing.
  • Ask your finance team to hold billing any more audit-related claims unless you’re notified by us to do so.

Audited claims could include cases for:

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

Note: Catastrophic-cost outliers can only have charges rebilled up to 30 days before the audit. To learn more, see “Reminder: Here’s what you need to know about catastrophic case audits” in the November 2015 Record.

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 2016 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.