Payment Audits in Progress for Certain Claims
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is committed to providing affordable healthcare to our members, your patients.
To help manage and control the cost of healthcare, CareFirst has contracted with EquiClaim, a Change Healthcare Solution (“EquiClaim”) to audit certain hospital and facility claims.
You may receive a letter, starting in June, from EquiClaim on behalf of CareFirst asking for your assistance with these audits. Please provide the requested documentation to EquiClaim within 30 days of receiving the request and follow the instructions within the letter of where to send the documentation.
Note: Do NOT mail or fax any documentation to CareFirst.
EquiClaim will submit any audit findings back to the facility. Providers should return the audit agreement back to EquiClaim within 60 days.
For claims or member-specific questions or rejections, contact Provider Service at the number listed on the back of the member’s identification card. If you have more general questions, please visit our Looking for Support webpage at www.carefirst.com/providersupport.