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Recommendation Details
Text of Recommendation
We recommend that the contracting officer direct the Association to update its FAM to instruct local BCBS Plans to manually price claim lines with modifiers requiring medical review/approval at the appropriate Medicare amount with applicable modifier price adjustments.
Recommendation Number
9
Recommendation Status
Open
Significant Recommendation
No
Recommendation Questioned Costs
$0
Recommendation Funds for Better Use
$0
Associated Report Details
Submitting OIG
Office of Personnel Management OIG
Linked Report
Audit of Claims Processed in Accordance with the Omnibus Budget Reconciliation Acts of 1990 and 1993 at All Blue Cross and Blue Shield Plans for Contract Years 2019 through 2021