BCBSND is enhancing our core claims processing with the Payment Integrity Program. The program will enhance current capabilities to ensure payments are correct, assigned to the right payer and consistent with national standards and guidelines.
We have partnered with Cotiviti, a leading health care analytics company, to bring a new level of accuracy to claims processing. This new enhanced level will supplement our core in-house system of robust checks and balances.
The Payment Integrity Program implements a robust Retrospective (post-pay) and Prospective (prepay) analysis of claims.
The following retrospective audits will begin in Q3 of 2022 and will be phased in through the end of Q4 2022. To learn more about the Payment Integrity Program, types of audits and timelines, you can view our Education on Demand (EOD) presentations.
Starting Q4 of 2022, claims will go through two different Prospective reviews.