CommercialAdministrativeMedium impact
[Georgia] Continued collaboration on DRG clinical and coding validation
Anthem BCBS·GA·Coding
Effective date
Jul 23, 2026
We identified it
Jul 28, 2026
Summary
Anthem Blue Cross Blue Shield (Georgia) is continuing its DRG clinical and coding validation audit program through its Complex and Clinical Audit (CCA) team and designated external vendors (EXL and Ceris). Healthcare providers should expect ongoing medical record requests and audit correspondence from Anthem and/or its vendor partners. The audit processes and medical record request procedures remain consistent with prior practices.
Action Required
Effective immediately: Billing and medical records teams should prepare for continued DRG validation audits from Anthem's CCA team and external vendors (EXL and Ceris). Establish or maintain protocols for timely response to medical record requests from Anthem and designated vendors. Designate a point of contact for audit correspondence and ensure medical records staff are trained to prioritize these requests. Track all audit requests to help Anthem minimize duplicate record requests. If questions arise regarding specific audits, contact your Anthem provider relationship management representative. Failure to respond timely to medical record requests may result in claim denials or audit findings.