June 2021

EXL Health to Review Complex Claims July 1, 2021

Our post-payment reviewer of complex claims is changing. Starting July 1, 2021, EXL Health will conduct post-payment reviews of complex claims from providers and facilities on behalf of Blue Cross and Blue Shield of Illinois (BCBSIL). EquiClaim, a Change Healthcare Solution, won’t conduct reviews of complex claims filed after June 30, 2021.

This means that for claims filed after June 30, 2021, EXL Health will contact you if your claim was incorrectly paid.

EXL Health will review claims for:

• Compliance with the provider agreement
• Compliance with clinical payment and coding policies
• Accuracy of payment

If a claim is determined to be reimbursed incorrectly, EXL Health will tell you how to repay the funds or appeal the decision. BCBSIL may recoup payment for any claim that doesn’t meet our policies. For more information, refer to our Provider Manuals.

Questions? Contact your BCBSIL Provider Network Consultant.

EXL Health is an independent company that has contracted with BCBSIL to provide medical claim audits for members with coverage through BCBSIL.

EquiClaim, a Change Healthcare Solution, is an independent company contracted with BCBSIL to provide medical claim audits for members with coverage through BCBSIL.

BCBSIL makes no endorsement, representations or warranties regarding third party vendors and the products and services they provide.