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September 2023
Cost of external peer reviews to increaseWhat you need to know Providers will need to pay the cost of appeal reviews if the peer review agency upholds Blue Cross’ decision regarding a claim. The cost of external peer reviews for facilities (including hospitals) and doctors’ offices will increase, effective Sept. 1, 2023. Health care providers typically request peer reviews when they dispute an audit finding. Here’s a look at the current and new fees: Facility standard clinical review Facility coding review Professional standard clinical review Professional standard coding review According to Blue Cross Blue Shield of Michigan and Blue Care Network participation agreements with health care providers, if the peer review agency upholds Blue Cross’ decision regarding a claim, the facility or practitioner’s office will pay the cost of the appeal review. |
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