Publication Date

Publication Date: 

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) contracted a vendor to audit Blue Medicare claims, prior to their release for payment. The pre-payment audit begins in May 2017, and will be ongoing. Medicare Advantage claims submitted by contracted and non-contracted providers will be included in the pre-payment review.

The audit will initially focus on claims relating to:

  • Add-on code billing errors
  • Bundled services and supplies
  • Duplicate claims
  • Established patients billed as new patients
  • Inconsistent places of service
  • Missing professional or technical services modifier
  • Global surgical periods

Claims will continue to process within established contractual and Centers for Medicare and Medicaid Services (CMS)-required timelines. Additional pre- and post-payment audits may be added in the future without advance notice, as identified within standard current industry and procedural coding guidelines. 

If you have questions about the pre-payment audit, please call the Blue Medicare provider customer service team at 1-888-296-9790.