Commercial pharmacy audits begin April 2019

Blue Cross Blue Shield of Michigan is using SCIO Health Analytics, an independent company, to conduct compliance audits on 2018 pharmacy claims.

The audits will be claim-specific and help ensure that paid claims were accurately billed according to Blue Cross and Blue Care Network pharmacy guidelines, as well as state and federal laws.

Please be prepared to share prescription records for review. After an audit, SCIO will send the findings letter and, if necessary, information on how to seek an appeal. Any audit recoveries will be paid to Blue Cross Blue Shield of Michigan as directed in the audit letter.

Pharmacies are required to comply with audit requests from Blue Cross, BCN or its agents according to the terms and conditions of the pharmacy network participation agreement.

Questions?
Contact your SCIO provider service representative at 1-866-628-3488, ext. 7414.