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March 2018

Changes coming to the way we handle provider audits

Starting June 1, 2018, Blue Cross Blue Shield of Michigan will change how we finalize provider audits.

  • We will adjust billing and compliance audit findings at the claim level and at the time of the audit. Disputed claims will be eligible for a one-step internal appeal for reconsideration.
  • We will offer a two-step process for medical necessity audits. It will consist of an internal review and independent external review. Adjustments will be done at the claim level and will be taken after the second appeal is complete.
  • For all audits, Blue Cross will no longer accept checks or accounts receivable for finalizing the audit.

Look for more information about these changes in future issues of The Record.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.
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