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.
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
procedure code and description 99241 - Office consultation for a new or established patient, which requires these 3 key components: A pro...

No comments:
Post a Comment