Log In
New DRG Dispute time frames
Effective immediately, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) providers will have a 45-day period available to them for vendor conducted post-pay DRG clinical coding reviews. This is a change from the current 30-day period to dispute findings. Providers will begin to see letters reflecting this change from vendors on the following effective dates:
Apixio: 12/04/2024 or sooner
Equian: 11/11/2024
This is in keeping with other dispute periods issued for other coding reviews.
For additional information regarding previously posted communication about DRG Program and Readmission Reviews visit this provider news.
Impacted Market Segments
The DRG clinical validation reviews will be conducted on postpaid claims in the following market segments:
- Fully Insured Large and Small Groups
- Administrative Services Only (ASO)
- Individual
- State Health Plan (As of January 2022)
- IPP / Blue Card Program
- Medicare Advantage & Experience Health
The program will not include Federal Employee Program market segments at this time.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
Information in other languages: Español 中文 Tiếng Việt 한국어 Français العَرَبِيَّة Hmoob ру́сский Tagalog ગુજરાતી ភាសាខ្មែរ Deutsch हिन्दी ລາວ 日本語
© 2024 Blue Cross and Blue Shield of North Carolina. ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. All other marks and names are property of their respective owners. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.