March 3, 2022
As part of Premera’s overall Payment Integrity program, Premera works with Carewise Health to perform hospital bill audits. Hospital bills are currently being audited to check billing appropriateness, ensuring Premera has been billed correctly for services
and/or supplies. Carewise Health may need to obtain medical records or other documentation to perform an audit.
The following change to the existing audit process will be in effect as of 4/3/2022.
If medical records or other documentation is not received within the timeframe specified within the initial request letter, which is typically 90 days, Carewise will submit the claim to Premera, and the entire claim amount will be subject to a refund
request and appeal rights will be forfeited. Facilities can request additional time to provide documents through Carewise Health.
If you have any questions, contact your Provider Network Management representative or call Carewise Health directly at 502-326-4526.