Supplier partner change for commercial DRG audits begins November 2021

EquiClaim, an independent company that provides auditing support for Blue Cross Blue Shield of Michigan and Blue Care Network, will perform claim audits on inpatient hospital diagnosis‑related groups, or DRGs.

The audits will:

• Focus on DRG coding validation.
• Review data going back one year.
• Base the look-back time frame on the date the claim was paid.
• Require providers to submit medical charts.

Medical records will be reviewed to:

• Facilitate accurate claim payments.
• Detect, prevent and correct fraud, waste and abuse.

You’ll need to provide medical charts for review at the time of an audit. After an audit, EquiClaim will send you a letter with the findings and information on how to request an appeal.

Contact the EquiClaim Customer Service Line at 1-866-481-1479 if you have any questions or need to request an extension.