EXL Health Is Reviewing Complex Claims

As we told you in May, EXL Health is conducting post-payment reviews of complex claims from providers and facilities on behalf of Blue Cross and Blue Shield of New Mexico (BCBSNM).

Reminder: This means that for commercial and Medicaid claims filed after June 30, 2021, EXL Health will contact you if your claim was incorrectly paid. Watch for reviews from EXL Health starting in February 2022.

EXL Health is reviewing claims for:

• Compliance with the provider agreement
• Compliance with clinical payment and coding policies
• Accuracy of payment

If a claim is determined to be reimbursed incorrectly, EXL Health will tell you how to repay the funds or appeal the decision. BCBSNM may recoup payment for any claim that doesn’t meet our policies. For more information, refer to our Provider Manuals.

Questions? Contact your BCBSNM Provider Network Representative.

EXL Health is an independent company that has contracted with BCBSNM to provide medical claim audits for members with coverage through BCBSNM.

BCBSNM makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.