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.
