On-Site Review

Policy Number: GP-X-002

Last Updated: Dec. 13, 2022 

There are times when Blue Cross and Blue Shield of Nebraska (BCBSNE) may request an on-site review with a provider’s practice or institution.  

Reasons for an on-site review include, but are not limited to:

  • A general visit following a member complaint
  • Suspected fraud, waste and/or abuse of service 
  • Review best practices for billing  
  • General review of all provider practices to maintain and continue our partnership  
  • When credentialing is delegated  

An assessment will be made by a BCBSNE designated individual attending the on-site visit, and a summary of the findings will be given to the provider. The outcome of the on-site visit will determine if a corrective action plan will be initiated. Should a corrective action plan be required, that information will be included in the summary.