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Prepayment Inpatient Claim Review

As previously communicated in a June IAI, we've partnered with Equian, a nationally known payment integrity vendor, to help continue to manage costs and improve the accuracy of claim payments. Blue Cross has a broad spectrum of programs throughout the healthcare system targeted at identifying and mitigating costs associated with high dollar claims. This partnership adds to that spectrum by enhancing our pre-payment review process for certain high dollar inpatient claims. This enhanced review process began on April 1, 2018 for fully insured accounts, and ASC accounts will be included effective January 1, 2019, upon renewal.

You don't need to take any action to be included in this process. Qualified claims will be automatically identified for review. There will be no impact on members. For more information, please contact your account executive.

Blue Cross Blue Shield of Massachusetts

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