What types of adjustments are not considered exception payments?

Adjusting claim payments on appeals that arise from the following situations will not constitute making an exception payment, and may be corrected for all groups:

  • Incorrect processing edits 
  • Group files not updated 
  • Incorrect benefit information loaded to the processing system 
  • Inaccurate information provided to the member in written communications 
  • Inaccurate or unclear benefit information given by a Blue Cross Blue Shield of Michigan or Blue Care Network representative to a member 
  • Services that are a benefit for the account but which cannot be processed by our internal systems 

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