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Post-payment Review for Implant Claims from Stand-alone Ambulatory Surgery Centers

Posted September 16, 2019 (Updated September 24, 2019)

This notice has been revised to refer to EquiClaim (rather than Change Healthcare) as the vendor that will provide post-payment review.

We are changing the way we review claims for implants performed at free-standing ambulatory surgery centers (ASCs). EquiClaim currently reviews implant claims submitted by hospitals and hospital outpatient departments for services provided to our members. As of Dec. 15, 2019, EquiClaim will also provide post-payment review for all ASC claims with implant charges.

Claims containing implant charges in any combination of revenue and procedure codes will be reviewed for:

EquiClaim will let you know if your claim for an implant was paid in error. They will tell you how to repay the funds or appeal the decision.

As a reminder, we may recoup payment for any device that does not meet our requirements. For more information, refer to the appropriate provider manual in the Standards and Requirement section of our Provider website. 

If you have questions, contact your Blue Cross and Blue Shield of Illinois (BCBSIL) Provider Network Consultant.

EquiClaim, a Change Healthcare Solution, an independent company, provides payment integrity solutions for BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by independent companies such as EquiClaim. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.