Itemized Bill Review of Facility Claims

  • July 2, 2020

    To keep healthcare premiums affordable without compromising quality or efficacy, Premera is working with CERiS to perform itemized bill reviews on facility claims.

    This review process is intended to identify errors, duplicate charges, capital equipment, routine services/supplies, unrelated charges, and non-separately billable charges on facility claims for inpatient and outpatient services, on a prepayment basis.

    Facility claims should be billed and appropriately coded according to policies along with industry standards for the bill type including but not limited to:

    • UB Editor
    • AMA
    • CPT, CPT Assistant
    • HCPCS
    • DRG guidelines
    • CMS National Correct Coding Initiative (CCI) Policy Manual
    • CCI table edits
    • Other CMS guidelines

    If a provider’s contract doesn’t specify which items and services are routine or ancillary, CERiS will use payer policy and standard industry practices to identify routine service and supply charges that aren’t separately billable.

    Starting August 1, 2020, Premera or CERiS may request documentation (such as the itemized bill) to conduct the line item review. If you’re contacted, we ask that you submit the requested information within 7 calendar days.

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