BCBS Medicaid Overpayment

sfoster 7 years ago in Payments/ERA Modules updated 6 years ago 22

Has anyone else received their letter/invoice from BCBS in regards to the overpayment of Medicaid claims that were paid at a CMHC level, incorrectly? And is so, what is your plan to identify and "internally" re-process ALL of the affected claims?

There is another thread/post about this. I called and questioned their figuring on our UA codes, since those pay at the same rate regardless of whether or not your are classified as CMHC. They are re-figuring our invoice. They have also sent us recoupments for after the dates covered in the invoice - which we also submitted inquiries regarding. Those are also figured incorrectly in regard to UA codes and U1/U1 HQ codes. I think they all-too hastily tried to bill all of us, without having their facts correct. Definitely challenge the amount and request a detailed invoice.

Sarah, how did you inquire, via email (BHquestions@bcbsmn.com)? or did you call the provider line?

Hi Sarah, What is the title of the other thread on this subject? I assume the UA billings are for CTSS? I sent an email the day after receiving our "invoice" and the following day received an email with a large spreadsheet attachment identifying every claim effected during this 10 month period. Which is nice, but certainly doesn't help identify quickly to which clinician all of these claims belong. Uhhh! I also spoke to a BCBS rep and she indicated that we would be receiving an ERA identifying all of these "over-payments". What a nightmare. Thanks, Sara

The other thread is titled Blue Plus Payments.


Yes, the UA modifier is for our CTSS billing. 

I still have not received my spreadsheet, so I am getting a little worried. Have you received other recoupment correspondence (ours come via US mail) for the time period after this 10 month period? 

I received a 4-page document listing recoupments which was also incorrect. It has DBT codes processed as adolescent (when clients are well over the CTSS age allowance), and CTSS codes reprocessed as non-UA codes. I think we need to be aware that they are apparently using a computer program to pull out these codes, and it is not programmed correctly! 

If we all start appealing these recoupments, perhaps they will take a look at their process. They processed our U1 modified codes last year, all as UA codes. It is a significant decrease in remittance amount, and took almost six months to get corrected. That was chalked up as a programming error by BCBS. 

I am hoping, with enough of us challenging their recoupments, they will actually take a look at their process. Fingers crossed!

I actually called the 800 number and kept asking for a representative, until I was able to get to Eric Hoag's voice mail (that is who our invoice was from) and left a message that I wanted a detailed invoice, and that I was disappointed in the correspondence/invoice I had received and the lack of information. 

He passed my call on, and I had a voice mail from a Diana. She referred me to the BHQuestions email address, but I called her back, as well. When she tried looking up my invoice, and I voiced my concerns regarding a recoupment we had received the day before that had not been figured correctly - she noticed some discrepancies in our information associated with the invoice I had received. 

When I did not receive my detailed report by 2:00 p.m. that afternoon - I left her another voice mail asking when I should expect the information. I then received an almost immediate email from BHQuestions stating they were re-figuring my invoice. 

That was on Monday, and I have yet to receive my detailed information or my corrected invoice. Good luck! I think it is in all of our best interest to question each and every item they are attempting to take back!

I emailed the BHquestions email address and got my Excel spreadsheet the next day listing all the claims affected. Nevertheless, we plan to get our lawyer involved and not pay.

Has anyone contacted AAMFT or APA on this? Wondering if we could utilize this legal resource? Also, should anyone choose to utilized legal recourse, it may be an idea to send several together through one lawyer versus several separate.


Our Clinical Director has been in contact with America Psychological Association who said they are working with MN Psychological Association.  We did receive our invoice. The initial invoice just had the dollar amount due with no details. We called and were told to email an inquiry in order to get the details. They then sent a detailed invoice but it did not have client names or providers listed. So we sent another email to get names and specific providers which they did send, however, 10 claims had NA listed for the client and the provider.  We then contacted them again and asked for the details of those claims. It was then that they recognized some changes to pervious claims and they needed to adjust their invoice.  Still waiting for the update. Would recommend everyone thoroughly review the details of your invoices.

Out of curiosity, if attorneys are getting involved, what do you think the end result will be?  

Do you think BCBS would end up terminating contracts with those providers?  

Is it with the intention to get a longer period to pay back the amount you were invoiced?  

I still have not received my "corrected" invoice or detail.

Is anyone else considering not paying the invoice and letting it happen within Procentive in the form of takebacks?

Interested in the response on this.  We hadn't really considered this option. 

I received my updated invoice, and the total amount due was just over 1/3 the originally invoiced amount. We will be paying ours, instead of having it recouped through future reimbursements. With the recoupment covering a year's worth of reimbursements, I would be worried about the amount being recouped not being accurate. Especially since the original invoice amount was almost 3 times what it should have been - but that was our agency's experience. I don't know that it would hold true for all agencies.

Sarah, how did you let them know that their invoiced amount was inaccurate? Did you make notes on the invoice with details they sent? I have sifted through some of our invoice details and found that what they say they paid, the actual payment we received is off...by 1 cent, sometimes 30 cents, maybe more. It's also not so easy know what our allowed amount/contracted rate is since PMAP pays something like 20% less than the posted rate on fee schedules. This project is just so overwhelming! I have better things to do like get other claims paid instead of dealing with the details of this! We were hoping the MPA appeal would make BCBS forget out the overpayments but that did not go through.

I did email BH questions and asked for an extended due date, 6 months more for when our invoice amount is due. Whoever responded said they approve it, so now ours is due Oct 31, 2018. I asked if they would recoup the $ electronically as it states in the letter they would offset remits if payment was not received in full by April 30. The rep emailed back stating, he noted our account is flagged and will not be pulled into the accounts who will have money recouped automatically. He or she said there should be no issue, because our clinic is on the spreadsheet that he would review before sending it on to corporate finance. Even with these emails, it still worries me that in May we'll get a horrible remit full of recoupments because of a system error.

Perhaps other clinics could ask for a extension of payment as well.

I took the detailed information they sent me, and put in the corrected amount we should have been paid. There should not be a discount on CTSS codes, as the rates are the same if you have your CTSS certification. They were taking back the over 20% on those codes. There should also not be a discount on DBT codes, for a certified program. That left only one third of the invoiced codes subject to the recoupment on their over payment.

Having them recoup the funds sounds like a much better idea, as far as having the information in Procentive, as well as on our invoice. Thank you, Ashley for laying that out the way you did. I like the idea of having the ERA as "proof" of the process.

Good Morning!

In case it helps in the decision making process I want to mention what Procentive has been informed by BCBS: if a check is not issued to BCBS by the deadline, BCBS will recoup their funds using the standard takeback method (which most providers have some experience with).

This means that an ERA in Procentive will only be delivered if BCBS issues takebacks. Allowing BCBS to recoup their funds using takebacks requires BCBS to deliver an ERA - which will be a full accounting of the claims they are recouping for the services being recouped . The additional benefit to this method is that the records will be delivered to Procentive (as an ERA) and will require less manual posting.

If a payment is made to BCBS all posting in Procentive will need to be done manually, since no ERA will be sent.

Hello! One of our clinicians was informed by a BCBS rep that if they do takebacks through an ERA that it will NOT be itemized, but rather just simply state the dollar amount being used to pay for the new claims as an offset to the outstanding invoice. Thoughts?

There has been a LOT of discussion about this problem (non-itemized documentation by BCBS) on MPA listservs, and I believe MPA has pushed back against this.  I know that some psychologists have reported on the listservs that they have refused to pay unless provided an itemized list, and some have received this info.  I believe that part of their  reasoning has been that they need to know which patients/clients are involved in order to correct documentation in their billing records. Anyhow, this has clearly been a major mess. 

Upon request we did receive a spreadsheet that itemized the claims involved. What I was referring to was if a company chooses not to pay BCBS and instead let them pay off the invoice in the form of takebacks. When they send an ERA that would be affected, they would simply reference the total amount of the remit being deducted from the outstanding Medicaid Overpayment invoice. Then we'd have to decide which claims to manually perform the takeback against, etc. in Procentive.

Yes. They will not be sending an ERA in the way they usually do - with each client's information listed separately. It will just be one lump-sum amount. I commented on another post, with the information I received from BCBS. They sent me this explanation:

Claims will not be adjusted so you will not see these on your ERA as adjustments rather there will be a forwarding balance at the top of the remit and money would be held from that remit from what we would have paid. 

We will have to manually enter the information from the spreadsheet BCBS sent in association with the invoice.

Well, May 1st has come and gone. Has anyone rec'd an ERA with any information regarding the balance of your overpayment invoice? The first ERA I rec'd after May 1st, came in with a pay date of May 8, 2018, but an adjudication date of April 30, 2018. It looked normal. I thought perhaps this one wasn't affected because of the adjudication date was in April. Then I rec'd a second one. This one was adjudicated on May 4, 2018 with a pay date of May 8, 2018; however, this one too looked totally normal. Anyone else?