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Premera Extends CERIS to More Groups Starting December 1

December 7, 2023

CERIS is a third-party vendor that performs itemized bill review on a subset of acute facility claims. Starting December 1, 2023, CERIS reviews will apply to additional lines of self-funded Premera business.

Which claims are reviewed by CERIS?
Claims that meet the following criteria are reviewed by CERIS:

  • Acute facility only (inpatient and outpatient)
  • Pricing methodologies:
    • Percent of billed charges and diagnosis-related group (DRG) outlier
  • Allowed amount of equal to or greater than $50,000
  • BCBS host, fully insured, and self-funded members
  • Washington and Alaska

For more details, read the July 2 article, Itemized Bill Review of Facility Claims.

If you have any questions about CERIS, contact your Premera provider representative.