Optum to perform outpatient facility audits on Blue Cross commercial claims starting in March 2022

Optum, an independent company that provides auditing support for Blue Cross Blue Shield of Michigan, will perform audits on outpatient facility claims for Blue Cross commercial members, beginning in March 2022.

The audits will:

• Focus on commercial outpatient facility claims.
• 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.
• Determine coding accuracy.
• Confirm compliance with laws and policies.
• Validate contractual requirements and utilization standards.

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

If you have questions or need to request an extension, contact an Optum provider service representative at 1-877-787-2310 from 8 a.m. to 4 p.m. Eastern time Monday through Friday.