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DPAP 203

Claim Overpayment and Recoupment


Provider Administrative Policy

Section
Information
Policy Date
January 2012
Status/Date
Revised/May 2015
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, 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.

If you, the provider, detect a claim overpayment situation, please submit notification through the email post service claim process. Blue Cross of Idaho is only able to adjust claims on your remittance advice and will not accept cash refunds. Cash received will be returned to the provider.

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. 

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.


Policy History

Date Action Reason
May 2015 Revised Clarified overpayment process