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.