Reminder: Guidelines for collecting cost-sharing amounts

We want to remind providers that our participating agreements prohibit, except in certain circumstances, the waiving of member cost-sharing amounts. Offering discounts on member cost-sharing liability for prompt payment or for other reasons is prohibited.

The only permitted exception, as stated in our participation agreements, are for hardship cases that are documented in the member’s records or when reasonable collection efforts have failed.

Our guidelines are as follows:

• Collecting cost-sharing amounts, such as copayments and deductibles, at the time of service, registration or admission, does not violate Blue Cross Blue Shield of Michigan’s participation agreements as long as the amount collected is not more than the member’s liability.

• For elective or routine services, health care providers may insist on payment of known member liabilities at the time of service, registration or admission.

• If it’s later determined that there was an overpayment, providers must promptly refund the overpayment to the member.

• Providers are not permitted to mandate that members provide credit card information in order to secure any future balances. However, members may voluntarily choose to do so.

BCBSM makes information about member eligibility, benefits and cost-sharing available through web-DENIS and CAREN. Because a member’s eligibility for coverage can change at any time, our provider participation agreements require providers to verify eligibility at the time of service or admission, even if previously verified.

To reiterate, based on our participation agreements, it’s prohibited to waive member cost-sharing. This includes offering discounts for prompt payment or other reasons that reduce member liability.

It’s important for providers to submit timely claims so that we can keep our member cost-sharing information as up-to-date as possible.

For more information, contact your provider consultant.