CERiS to Review Complex Claims
One of our post-payment reviewers of complex claims is changing. CERiS will continue to conduct post-payment reviews of complex claims from providers and facilities on behalf of Blue Cross and Blue Shield of Texas (BCBSTX). However, for claims filed beginning July 2021, EquiClaim, a Change Healthcare Solution, will no longer provide these reviews and you will no longer be contacted by them if your claim was incorrectly paid.
CERiS will continue to 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, CERiS will tell you how to repay the funds or appeal the decision. We may recoup payment for any claim that doesn’t meet our policies. For more information, refer to our Provider Manuals.
Questions? Contact your BCBSTX Network Representative.
CorVel Healthcare Corporation, dba CERiS is an independent company that has contracted with BCBSTX to provide medical claim audits for members with coverage through BCBSTX.
EquiClaim, a Change Healthcare Solution, is an independent company contracted with BCBSTX to provide medical claim audits for members with coverage through BCBSTX.
BCBSTX makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.