Outpatient audits of Medicare Plus Blue professional claims to begin in October

An audit of Medicare Plus Blue℠ outpatient professional claims will be performed in October by EXL, an independent company that provides auditing support for Blue Cross Blue Shield of Michigan.  

The audit will include select professional claims that correspond to facility claims with CPT codes that range from *10004 through *69990.

The initial review performed by EXL will use the facility’s medical records to compare a facility surgery claim with the physician’s professional claim to identify any billing inconsistencies with CPT or HCPCS procedure codes. Medical records won’t be requested for the physician’s professional claim.

Once you receive a patient listing with an audit notice letter:

• No further adjustments can be made to the related claims.
• No rebilling is allowed to correct a billing mistake or other errors.
• Inform your billing and finance departments of the claims being audited.

After an audit, EXL will send a letter with findings and information about requesting an appeal, if applicable.

If you have questions, call EXL’s customer service number at 1-833-717-0378.