Premera Extends CERIS to more Groups Starting December 1

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.