Enhancements to PPO outpatient claim editing process coming in April

In the September 2018 Record and the December 2018 Record, we told you how we’re updating our claim editing processes for select groups starting in December 2018. We also informed you that the outpatient facility implementation would occur in second-quarter 2019.

The outpatient facility claim enhancements will occur on April 5, 2019. Unique clinical editing reason codes will appear on the 835 response files or provider vouchers.

We hope these enhancements will make our claims payment system easier for you and your billing staff to navigate.

If you have questions about the Blue Cross Blue Shield of Michigan claim editing process, contact Provider Inquiry – Professional at 1-800-344-8525 or Provider Inquiry – Facility at 1-800-249-5103.