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Wiki BCBS GA audits

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CEMMETT

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I work with a small anesthesia group in GA, beginning 1/1/2017 BCBS GA started auditing ALL the claims using adjustment codes 16 and 252.
In March, they published a new policy regarding “Professional Reimbursement” outlining the triggers for medical record audits with the guidelines.

We have complied with the policy, sent the medical records but still minimal claim adjudication/payment.

Is anyone else experiencing the same situation with BCBS GA?

We question if this is a tactic to force in-network participation?

Any feedback is appreciated.

Also, please share a BCBS GA Claims/Operations point of contact.

TY,
Cindy
 
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