EXL Health to Review Complex Claims July 1, 2021

May 13, 2021

Our post-payment reviewer of complex claims is changing. Starting July 1, 2021, EXL Health will conduct post-payment reviews of complex claims from providers and facilities on behalf of Blue Cross and Blue Shield of New Mexico (BCBSNM). EquiClaim, a Change Healthcare Solution, will not conduct reviews of complex claims filed after June 30.

This means that for claims filed after June 30, EXL Health will contact you if your claim was incorrectly paid.

EXL Health will review 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 Network Representative.

EXL Health and EquiClaim, a Change Healthcare Solution, are independent companies that have 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.