New Process for Payment Integrity

  • June 18, 2020

    Premera is working with MedReview, Inc. and Claris Health to review selected claims. This effort is for Individual Plans only.

    MedReview is assisting Premera in diagnosis-related group (DRG) validation and hospital bill review processes. Starting this summer, you may receive a request for additional information such as an itemized bill or patient medical records. We ask that you provide the required documentation within the timeframe listed in the request.

    Claris Health is performing coordination of benefits review of paid claims to confirm they were paid appropriately. If an overpayment was detected, you may receive a request for a refund. The details of Claris Health findings will be provided in a request letter.

    Claris Health and MedReview will provide contact information for questions or to learn more about their process when they contact you for review.

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