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January 2022
Reminder: Optum provides claim editing for professional and facility claimsIn November 2021, Optum began editing commercial claims for Blue Cross Blue Shield of Michigan professional and facility providers. We initially informed you of our partnership with Optum for enhanced claim editing in the August edition of The Record. Health care providers will see these new edits as we continue our ongoing effort to promote correct coding and enhance our claims payment systems. You'll be able to recognize the edits by the unique provider message codes K500 through K544. The Optum medical records request component of this initiative is expected to begin during the first quarter of 2022. If you receive one of these edits, submit a corrected claim when appropriate. Providers should continue to follow the current clinical editing appeals process if they believe the services rendered warrant an exception. |
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