Blue Cross Blue Shield of Michigan issues Medicare Advantage claim overpayment reports

After reviewing its records, Blue Cross Blue Shield of Michigan determined that it overpaid some Medicare Advantage providers for services provided to BCBSM Medicare Advantage members. Providers who are affected will receive a letter with more details.

This overpayment occurred on our former claims processing system, PGBA, and will be transferred to our new claims processing system, ikaSystems. Affected providers will receive a PGBA claim overpayment information sheet that includes the recovery amount and the members who received services.

The ikaSystems remittance will deduct any claim overpayments, which may result in no payment or a reduced payment in the future. If any money is owed to you, it will be included in your notification or sent separately. We’ll also include a current remittance that details current claims payment information from ikaSystems.

We apologize for any inconvenience this may cause. If you have any questions, call our Medicare Advantage Provider Inquiry department at 1-866-309-1719 between 8 a.m. and 4:30 p.m., Monday through Friday.

To review our recovery and provider disputes process in more detail, visit the overpayment page on our provider website.

Following is a screen shot of the report and an overview of the information the report contains.

1. Tax ID: The Tax ID used to match the PGBA overpayment with the ikaSystems check
2. Provider name: The provider name associated with the overpayment
3. National provider identifier: The NPI associated with the overpayment
4. Claim number: PGBA claim number associated with the overpayment
5. Original amount owed: The original amount of the overpayment
6. Refund reason code: The reason for the overpayment
7. Subscriber name: Patient name related to the overpayment
8. Subscriber contract number: Patient contract number with BCBSM Medicare Advantage
9. Patient control number: Patient account number submitted by the provider
10.  Begin date of service: Beginning date of service on the overpayment
11. End date of service: Ending date of service on the overpayment
12. Total charge: The total charged amount on the overpayment
13. Accounts receivable number: Unique number related to the overpayment
14. Date created: The date the overpayment was identified
15. Date received: The date the payment was offset or the check was received from the provider
16. Amount received: The amount applied to the overpayment
17. Check number: The check number of the offset amount or the check received from the provider
18. Check Source:
    1. Ika – New system offset
    2. PGBA – Old system offset
    3. Provider – Check received from the provider
19. Totals by tax ID:
    1. Total original amount owed – Total of all claims original amount overpaid
    2. Total amount received – Total of all amounts received as of the date of the statement
    3. Remaining balance owed – The balance of the overpayment the provider still owes BCBSM
20. Total checks offset this statement:
    1. Check number – Check number used for the overpayment
    2. Check amount – Total check amount
    3. Check date – The date of the check
    4. Check source – The system the check was generated from
    5. Amount offset for Accounts Receivable – Amount of check taken for overpayments
    6. Remaining check balance – Any amount of the check due to the provider
21. Refund reason code description – Detailed description of the overpayment