As part of the 2024 Provider Audit Work Plan, Blue Cross Blue Shield of North Dakota (BCBSND) is informing providers that the Special Investigation Unit (SIU) and Provider Audit department are building the 2024 Provider Audit work Plan.
The Provider Audit Work Plan at this time will include scheduled audits to review:
- Laboratory claims
- Radiology claims
- Modifier use
The Work Plan is subject to change based on emerging risks. These audits will not impact all providers, as they are selected by a random claim selection. Per the SIU and Provider Audit process detailed in the BCBSND Provider Manual, claims identified as potentially at risk of inappropriate submission, coding or payment are selected for additional review. Medical records and any additional information, if required, will be requested from the provider or facility with an identified due date.
For additional information on the SIU and Provider Audit department and process, please see the BCBSND Provider Manual Special Investigations Unit section.
