State Regulatory & Insurance Committee (SRIC)
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BCBS of Michigan Optum Medical Record Audit on 99285’s
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BCBS of Michigan Optum Medical Record Audit on 99285’s
Optum and BCBS of Michigan have been slowly ramping up Medical Records requests over the last nine months as part of, what they are calling, their “Pre Pay Program”. When we first discovered this issue – it didn’t seem to fit any patterns. And when discussed with our BCBSM Rep we were advised that it was the ICD-10 code that was triggering the medical record request per her internal contact. Just this past week BCBSM issued their monthly newsletter, “The Record”, and it very clearly calls out PPO claims with 99285’s as triggering medical records requests to check for supporting documentation of that level.
This is an understandable practice on occasion, but they are burying us in paperwork. This article reads like there is more to come, on possibly EVERY 99285 – as they don’t hint at any random type of selection, nor what their selection process is outside of the level itself. I have an email out to our provider rep regarding this article and will provide any additional information as I get it.
Here is the address to the article – the link wouldn’t link in the discussion – but if you highlight, right click, it will give you the option to go to the article directly.
https://www.bcbsm.com/content/dam/microsites/corpcomm/provider/the_record/2024/may/Record_0524e.html
I’ve also attached the pdf below.
Thanks!
Carrie
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1 Reply
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QCDC should author a ltr to BCBS of MI regarding the burden of this practice.
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