For self-funded clients: An additional level of claims payment analysis

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As claims and billing systems become increasingly complex, the chance for coding and billing errors and fraudulent charges increases as well. In response, we’ve evolved our payment integrity strategy to add an enhanced claims analysis for self-funded clients.

The strategy now includes a two-tier system comprised of:

  1. Core Claims Analysis – In-house claims processing as you know it today, with a strong system of checks and balances.
  2. Enhanced Analysis – We’re partnering with other Blues plans and Cotiviti, the industry leader in health care analytics. Cotiviti’s technology examines billions of clinical and financial data points and applies decades worth of subject matter expertise to prevent and recover improperly paid claims.

For self-funded clients, enhanced claims analysis means more protection against wrongful charges—both accidental and intentional. Other Blues plans that have used Cotiviti’s services have reported an additional savings of 1% to 2% from their annual claims spend.

Effective dates: Out-of-state claims will include enhanced analysis beginning in April, which will be reflected in May billing. In-state claims will be incorporated later in the year.

If you’re a self-funded client with BCBSND coverage, your account executive will be in touch with supporting materials and answers to your questions.