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April 2020
DRG coding validation audits begin in June for Medicare Plus Blue claims
Beginning June 1, 2020, SCIO Health Analytics, an independent company that provides auditing services for Blue Cross Blue Shield of Michigan, will perform audits on Medicare Plus BlueSM hospital diagnosis‑related group paid claims.
The audits will:
- Review data going back one year.
- Base the look-back date on the date the claim was paid.
- Require providers to submit medical charts.
The audits will only focus on DRG coding validation, not clinical validation.
Medical records will be reviewed to:
- Detect, prevent and correct fraud, waste and abuse.
- Facilitate accurate claim payments.
Before an audit, be ready to share medical charts for review. After an audit, SCIO will send you a letter with the findings and information on how to request an appeal.
You may speak with a SCIO representative during an audit by calling 1-866-628-3488. |
