Optum to handle credit recovery efforts for Blue Cross and BCN

Effective Jan. 1, 2021, Optum^® has been assigned to identify and recover credit balance overpayments on behalf of Blue Cross Blue Shield of Michigan and Blue Care Network claims. Previously, these reviews may have been conducted by Conduent, formerly known as CDR Associates. Any review initiated by Conduent that is in progress will be completed by Conduent with an estimated completion date of February 2021.   

Optum conducts periodic claim reviews at provider locations. They’re a professional health care consulting firm that has focused on assisting both providers and payers by identifying and processing credit balances. Reviews only involve patient accounting records, not medical records. Claim recoveries will be handled through claims offset, not check refunds. 

Additionally, claims data will be available through a web-based tool for providers who choose to submit credit balance recoveries through Optum’s overpayment management tool.

Note: For Medicare Plus Blue℠ overpayments, providers may continue to submit a Request for offset of a Medicare Advantage overpayment form directly to Blue Cross using the existing process. This involves identifying the reason for the overpayment of a medical claim paid through IKA. The claim is then adjusted in IKA, resulting in an offset of future claim payments.