Reminder: Guidelines for collecting, determining cost-sharing amounts

In response to recent questions we’ve received, we’d like to reiterate our guidelines for collecting cost-sharing amounts.

• 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 request 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.

• Our participating agreements prohibit, except in certain circumstances, the waiving of member cost-sharing amounts. Offering discounts on member cost-sharing 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.

• 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.

Determining cost-sharing amounts
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 participation agreements require providers to verify eligibility at the time of service or admission, even it was previously verified.

If you’re charging the member at the time of service, you should check the Deductible/Copay screen in web-DENIS so you know what the member liability is for the services you provide.

It’s important for health care practitioners to submit claims in a timely manner so that we can keep our member cost-sharing information as up-to-date as possible.

For more information, contact your provider consultant.