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UPP Providers:
The Payment Recovery Program will become effective with claim refunds (i.e., duplicate payments, COB etc.) requested after April 22, 2005, for all BCBSIL contracting facilities and providers in our PPO, BlueChoice POS, BlueChoice Select and HMO product networks that participate in the Uniform Payment Program (UPP).
Program Highlights
1. A refund request letter will be sent explaining the reason for the refund, and advising the provider to return the refund as they currently do today.
2. We will continue to accept and report on the BC370 processing as we do today.
3. When a response or payment is not received to our initial letter, a follow up letter will be sent asking for payment and advising the facility that recoupment will be taken by BCBSIL through the new process.
New Process
If BCBSIL does not receive a response by telephone or in writing, and the provider does not return the amount of the overpayment within 30 days from the date of the follow up letter, we will recover the overpayment by offsetting current claims reimbursement by the amount due BCBSIL.
The recoupment deduction information will be included on your Provider Claim Summary (PCS), Electronic Remittance Advice (ERA) and UPP Monthly Statement.
Modifications have been made to the PCS, UPP Monthly Statement and ERA to support the auto-recoupment process.
The PCS will display:
- The total amount recouped toward the overpayments
- The net amount after recoupment has been applied
- Information regarding the specific overpaid patient account (i.e., patient name, patient account number, service dates, etc.), the amount of overpayment recouped and the overpayment reason
The 4010A1 ERA will display:
- A PLB segment with the DCN number and dollar amount of the adjustment
The UPP Monthly Statement will display:
- Any BC370 currently submitted as you do today
- A separate line for recoupment amounts (with corresponding voucher number on the PCS) if BC370 or refund is not received
Examples of the first and second refund letters, PCS, UPP Monthly Statement and BC370 are shown below.
If you have questions about this process, please contact your Provider Network Consultant.
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