Overpayment Recovery Program - BCBS FLORDIA update

Effective February 27, 2012, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) will implement additional changes to our Overpayment Recovery Program. These changes relax certain netting rules so our claims system can net (offset) overpaid funds quicker and more efficiently. Our new netting rules should make it easier for providers to reconcile accounts when it is necessary for BCBSF to recoup overpaid amounts.

Netting Across Lines of Business

• BCBSF will now offset overpaid amounts across different lines of business. In the past, because of  system limitations, BCBSF was limited to offsetting against the same type of claims only (e.g., State   Group, Federal Employee Program (FEP), etc.) However, our claims system will always attempt to  recover overpaid funds from claim payments for the same line of business first before netting from a
different line of business.

• There is no change to remittance advice data. You will see the same claims data that you see today.

Netting Across Different Addresses

• BCBSF will now offset overpaid amounts across different addresses (provider locations.) In the past,    we did not offset against different locations (addresses) operated by the same provider or physician   group. However, effective February 27, 2012, we will offset against another address if funds are not  available from the provider address (location) that was overpaid.

• The remittance advice will show details including the impacted provider name, provider number and claim(s) information to assist in reconciling accounts.

 Overpayment Disputes

• BCBSF may offset the portion of an overpayment that is not in dispute.
Example: BCBSF overpaid Dr. Jones $500. However, Dr. Jones disputes $300 of the overpayment. BCBSF may net (offset) the $200 amount not in dispute to go toward the overpaid amount, even if the dispute is not resolved.
Additional Information

• Providers may experience netting more frequently, because our processes expedite recovery of overpaid funds.

• To avoid netting, you must submit a payment to BCBSF within 40 days from the original request   refund (invoice) letter date, along with a copy of BCBSF’s request refund letter.

• If you do not submit the overpaid amount to BCBSF within 40 days, BCBSF will begin the netting    process.

• For general information about BCBSF’s Overpayment Recovery Program, providers may refer to the online Manual for Physicians and Providers at www.bcbsfl.com; select the Providers tab, Provider Manual and refer to the Overpayment Recovery Program section.

BCBSF will continue to enhance its Overpayment Recovery Program to increase efficiency and streamline processes. We will keep you informed as other changes are implemented. If you have additional questions, call the provider Contact Center at (800) 727-2227.

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