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June 2019

SCIO Health Analytics auditing outpatient claims for commercial business

SCIO Health Analytics®, an independent company that provides services for Blue Cross Blue Shield of Michigan, began auditing outpatient claims for our commercial business on May 1, 2019.

The audits will:

  • Start with claims paid on or after Jan. 1, 2018.
  • Confirm compliance with Blue Cross guidelines and policy.
  • Validate proper billing of revenue, CPT and HCPCS codes, modifiers and units.
  • Ensure services are documented.
  • Detect, prevent and correct waste and abuse.
  • Facilitate accurate claims payments.

You’ll need to provide the proper medical charts for review. After an audit, SCIO will send you its findings and instructions for appeal, if necessary.

If you need to speak to a SCIO representative during the audit, call 1-866-628-3488, ext. 7525.

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 2018 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.