Name of Manual - Blue Cross and Blue Shield of Minnesota

Compliance Audit
Integrated Health Management
Overview Your provider services agreement includes certain quality
assurance requirements. Pursuant to this agreement, Blue Cross
may conduct audits to evaluate a provider’s compliance with
medical necessity guidelines and standards of practice in the
community. Such an audit could include post-service claims
review, which may result in provider liability if the care is
determined to be not medically necessary or medically
inappropriate.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (06/19/12) 4-23