Empire to conduct post-payment reviews of distinct procedural services modifiers

In accordance with CMS guidelines, Empire BlueCross BlueShield HealthPlus (Empire) conducts post-payment reviews of professional claims for Medicaid Managed Care 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 1-800-450-8753.