Starting April 1, 2024, Blue Cross Complete will contract with OptumInsight, Inc., to ensure claims are paid accurately. Optum will perform periodic review of claims and related documentation to validate coding practices, payment accuracy, regulatory compliance, and adherence to Blue Cross Complete’s payment policies, utilization standards, and provider contract requirements.

It's important to keep in mind that if there are any irregularities, coding errors, or billing issues, claims may be denied. In such cases, a request to validate billed services may be made, which may require providing medical records to Optum. If the medical records received support the claims, the claims will be automatically processed for payment without requiring resubmission by the provider.

Click here to read the full announcement sent out by Blue Cross Complete.