BCBSNC Explains How It Will Recoup Overpayments for Bilateral Codes

Blue Cross and Blue Shield of North Carolina (BCBSNC) recently informed practices that it is working to resolve a technical system issue causing the overpayment of claims for bilateral procedures. The issue is limited to claims processed for BCBSNC’s under age-65, individual and small group members. Not all claims reporting multiple units on surgical procedures for these members are affected.

BCBSNC said they have identified the problem and are working to fix it, but in the meantime a manual process has been put in place to prevent further overpayments from being issued. This manual process began on Sept. 22, 2017.

They also are working to locate all processed claims for bilateral surgical procedures reporting units greater than one, which resulted in overpayments being issued. These queries review claims processed over the last 24 months. Claims identified to have been issued overpayments will be adjusted according to the providers’ contractual agreements.

The message requested that if the practice had not already refunded the overpaid amount, the recoupment request should arrive in early October. BCBSNC asked that practices wait until receiving the request to refund the amount. They also cautioned that the manual process is a temporary fix and a few claims might overpay until the permanent fix is installed. They anticipate this will be completed in November.

“We apologize for any inconveniences this technical system issue creates for you, and we appreciate your ongoing patience as we continue our work to resolve it,” the message said, directing any questions or need for assistance to BCBSNC’s customer service line: 1-800-214-4844.

The North Carolina Medical Society (NCMS) Solution Center also stands ready to help if necessary. Call the Solution Center at 919-833-3836 x142.


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