March 2019

Commercial home health service claims audit underway

In February, SCIO Health Analytics^®, an independent company working for Blue Cross Blue Shield of Michigan, began auditing claims for commercial home health services.

SCIO is conducting these audits to ensure that your billed and paid services over the past 18 months were ordered, medically necessary, documented, reported and covered under the patient’s contract, according to Blue Cross policies and guidelines.

If you’re a home health care provider, be ready to share medical charts for review.

After an audit, SCIO will share the findings and how to ask for an appeal, if necessary. The appeals process is simple:

For automated billing and compliance audits, disputed claims will be eligible for a one-step internal appeal.
For complex, medical necessity audits, an independent external review is the second step in the appeal process.

Have questions?
Contact your provider consultant. If you need to contact SCIO during an audit, call 1-866-628-3488, ext. 7526.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.