October 2019
Post-payment Review for Implant Claims from Stand-alone Ambulatory Surgery Centers
We are changing the way we review claims for implants performed at free-standing ambulatory surgery centers (ASCs). EquiClaim currently provides post-payment review of implant claims submitted by hospitals and hospital outpatient departments for services provided to our members. As of Dec. 15, 2019, EquiClaim will also provide post-payment review for all ASC claims with implant charges.
Claims containing implant charges in any combination of revenue and procedure codes will be reviewed for:
- Consistency with the provider agreement
- Consistency with clinical payment and coding policies
- Accuracy of payment
EquiClaim will let you know if your implant claim was incorrectly paid. They will tell you how to repay the funds or appeal the decision.
As a reminder, Blue Cross and Blue Shield of Illinois (BCBSIL) may recoup payment for any implant device that does not meet our requirements. For more information, refer to the appropriate provider manual in the Standards and Requirement section of our Provider website.
If you have questions, contact your BCBSIL Provider Network Consultant (PNC).
EquiClaim, a Change Healthcare Solution, an independent company, provides payment integrity solutions for BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by independent companies such as EquiClaim. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.