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New Options for Affordable Health Insurance

DPAP 203

Claim Overpayment and Recoupment


Provider Administrative Policy

Section
Information
Policy Date
January 2012
Status/Date
New/January 2012
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Blue Cross of Idaho works diligently on behalf of our members to develop contracting relationships with Idaho dental providers and Blue Cross Blue Shield dental affiliates (national Dental Grid).

 


Policy

Claim Overpayment and Recoupment

 If we detect a claim overpayment or recoupment situation for date of service on or after January 1, 2012, we will automatically credit previously processed Blue Cross of Idaho claims on your remittance advice. The remittance advice will specify the credit and date of the original payment.

For date of service on or after January 1, 2012:

  • Blue Cross of Idaho prefers providers not return overpayments for services given to our members. We will recoup the overpayment on the next remittance advice and we may send back any money you return for a claim overpayment.
  • Blue Cross of Idaho may credit or recoup routine claim overpayments up to 12 months from the last payment date. If a provider or member contract specifies a time frame other than 12 months, the contract requirements apply.

 

ASC Accounts - Providers returning money to Blue Cross of Idaho with the overpayment form may not see a credit on a remittance advice if the refund is for an ASC policy that has passed the claims run out period.

Providers accepting two payments - Two payments [Coordination of benefit (COB), third party liability (TPL), worker`s compensation or audits as allowed under the provider`s contract] are not routine overpayments and can be recouped/credited outside the 12-month period. Exception:

  • If you carry forward a credit balance for 90 days, Blue Cross of Idaho may send a letter requesting a refund to clear the credit balance.

Blue Cross of Idaho may not be able to credit your remittance in some situations. When returning an overpayment use the attached form to ensure we appropriately apply your credit. In some cases, Blue Cross of Idaho may send an overpayment letter requesting the return of a previous remittance payment.

Overpayment Return Form


Policy History

Date Action Reason