Blue Cross Blue Shield of Michigan issues Medicare Plus Blue^SM claim overpayment recovery letters

In reviewing our records, we discovered that we overpaid some providers for services to our Medicare Plus Blue members. We will attempt to recover the overpayments by reducing future claim payments.

You will receive monthly reports beginning in March 2015 that identify outstanding overpayments until the balance due is recovered.  For overpayment balances that exceed 60 days, please send a copy of the claim detail report along with a refund check made payable to Medicare Plus Blue to:

            Blue Cross Blue Shield of Michigan
            Attn:  FBD COB, Recoveries & Collections
            P.O. Box 441187
            Detroit, MI  48226-1187

Any unpaid balances that exceed 120 days may be referred to collections.  Also, under federal regulations, we may be required to report this issue to the Centers for Medicare & Medicaid Services.

We apologize for any inconvenience this may cause. If you have any questions, please 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, please visit our Overpayment page on our provider website.

Below is an explanation of the detail report that you’ll receive.

1. Date — The date the report was generated
2. Provider Name — The provider name associated with the overpayment
3. Provider Address —  The provider address associated with the overpayment
4. NPI — The NPI associated with the overpayment
5. Member ID — Patient’s Blue Cross Medicare Advantage contract number
6. Patient Name — Patient name related to the overpayment
7. Claim Number — Original claim number associated with the overpayment
8. Adj. Date (Adjustment Date) — The date the overpayment was identified
9. Dates of Service — Beginning and ending (if available) dates of service on the overpayment
10. Charged Amount — The total charged amount on the overpayment
11. Overpayment Amt — The original amount of the overpayment
12. Received Amt  — The amount applied to the overpayment
13. Balance Due — The remaining amount due from the provider
14. Adj Rsn (adjustment reason code) — The reason for the overpayment
15. Age in Days — The number of days between the Adj Date (adjustment date) and the last day of the previous month. If this number is greater than 60 then please see instructions in the letter to send in payment.
16. New Claim No. if avail — If the original claim number was adjusted the new claim number would appear here.
17. Total Number of Claims — Total number of claims on the report
18. Totals in Dollars
1. Charged Amt — The amount charged for all claims on the report
2. Overpayment Amt — The amount Blue Cross overpaid for all claims on the report
3. Received Amt — The amount we received from the provider for all claims on the report
4. Balance Due —  The amount owed by the provider for all claims on the report
19. Reason For Overpayment — Detail description for the Adj Rsn (adjustment reason code)