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99.91% claims accuracy: audit reveals quality service from BlueCross

One of our fundamental roles is covering and paying for health care claims — and everyone counts on us to be accurate and timely.

In fact, many of our large employer customers require regular audits to confirm we’re meeting our customers’ expectations. We’re always ready and willing to demonstrate our responsibility.

A recent third-party claims audit of the State Employee Health Plan, which we’ve served for almost 50 years, showed that BlueCross is providing excellent service and stewardship of our State of Tennessee members’ and customers’ dollars.

At the request of the Tennessee Attorney General, Healthcare Horizons Consulting (HHC) performed a comprehensive review of our state employee health plan members’ 2020 claims and audited random samples from 2020 through June 2021. Both showed BlueCross properly administered coverage for more than 102,000 state employees  during those time periods.

Getting it right the first time

Auditing standards require that auditors perform sufficient reviews to properly interpret and validate findings. HHC reviewed claims totaling nearly $759 million and found that:

  • BlueCross correctly processed and paid claims 99.91% of the time 
  • The accuracy of our payments to providers was 99.93%, giving us an error rate of just 0.17%, which far exceeds industry standards.

“We’re pleased with the findings of this audit, which show that we serve the best interests of both the State as a customer and our members,” says Maria Darras, vice president of commercial operations for BlueCross. “Our teams work hard to ensure our members’ claims are correctly processed and that they’re getting the coverage their plans include.”

Balancing choices and costs

Our State Employee Health Plan is designed to offer access to a variety of providers who deliver high-quality health care at a reasonable cost. We’ll continue to maintain our networks with a focus on partnerships that support affordable care.

About Alison Sexter, Communications Specialist

A photo of the authorAlison has been a member of the BlueCross BlueShield of Tennessee corporate communications team since 2015. A Chattanooga native, she has a decade of health care communications experience including writing, editing, public relations and social media.

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