Oct. 23, 2019
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BCBSMT to Review Implant Claims from Stand-Alone ACSs
At Blue Cross and Blue Shield of Montana (BCBSMT), we are changing the way claims are reviewed for implants performed at free-standing ambulatory surgery centers (ASCs). EquiClaim currently reviews implant claims submitted by hospitals and hospital outpatient departments for services provided to our members. As of Dec. 15, 2019, EquiClaim will also provide post-payment review for all ASC claims with implant charges.
Claims containing implant charges in any combination of revenue and procedure codes will be reviewed for:
- Consistency with the provider agreement
- Consistency with clinical payment and coding policies
- Accuracy of payment
EquiClaim will let you know if your claim for an implant was incorrectly paid. They will tell you how to repay the funds or appeal the decision.
As a reminder, we may recoup payment for any device that does not meet our requirements. For more information, refer to the requirements and provider manual on our provider site at bcbsmt.com/provider.
If you have any questions or concerns, contact your BCBSMT Provider Network Consultant.
EquiClaim, a Change Healthcare Solution, an independent company, provides payment integrity solutions for Blue Cross and Blue Shield of Montana.