Impacting claims dating back to at least August 2016.
August 17, 2017 | view this message in your web browser

North Carolina Society of Otolaryngology and Head & Neck Surgery

  

ALERT: BCBS Claims Overpayment

To: North Carolina ENTs

I received confirmation from BCBSNC today of a claims overpayment issue involving bilateral procedures that is likely to impact many, if not all, ENT practices across the state. BCBSNC has verified that they issued the overpayment for claims dating back to at least August 2016.

While there is a lot of information that we do not yet know about this situation, we do know that BCBSNC will be seeking repayment for the overpayments.

Here’s what we have been able to gather thus far from questions posed to BCBSNC:

 

Q: What is(are) the procedure(s) in question?
A: Any bilateral procedures.

Q: What BCBSNC plans are impacted?
A: Individual and Small Group.

Q: What is the timeframe of the affected claims – from when to when?
A: Onset was over a year ago - addressed in March of this year.

Q: What was the cause of the overpayment?
A: Configuration issue on Facets platform.

Q: Is the problem fixed?
A: It was addressed in March.

Q: What is BCBSNC’s plan going forward regarding the overpaid claims?
A: We will request the overpayments back via adjustments to the claims.

Q: What notices have been sent to physicians/practices regarding the problem?
A: No notices have been sent to my knowledge.

Q: Is the problem confined to ENT?
A: Any provider who renders bilateral services.

Even though there is a lot of information we do not have yet, we felt it important to alert all ENT practices of this situation. We are expecting more clarification, hopefully soon, and will provide updates accordingly.

W. Alan Skipper, CAE
Executive Director
North Carolina Society of Otolaryngology and Head and Neck Surgery
PO Box 27167
Raleigh, NC 27611
Phone: (919) 833-3836
Fax: (919) 833-2023
Email: ncoto@ncmedsoc.org

top of page

This message is a service of the North Carolina Society of Otolaryngology and Head and Neck Surgery (NCSOHNS)
www.ncoto.org | ncoto@ncmedsoc.org | Privacy Policy | Opt Out