Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) to conduct post-payment reviews of distinct procedural services modifiers

In accordance with CMS guidelines, Anthem conducts post-payment reviews of professional claims for Nevada Medicaid members billed with modifiers for distinct procedural services (modifiers 59, XE, XP, XS and XU). As part of these reviews, we may contact you with outlying billing practices to request additional documentation related to the services. If billing discrepancies are identified, we will provide you with a written report of our findings as well as your appeal rights and may initiate recoupment as appropriate. Findings may assist your office with quality improvement efforts.

 

For questions regarding post-payment reviews of distinct procedural services modifiers, contact Provider Services at 1-844-396-2330.

 

ANV-NL-0010-18 August 2018