Update to the Recoupment Policy for Blue Essentials^SM, Blue Advantage HMO^SM, Blue Premier^SM and HealthSelect^SM Network

Effective 09/15/2017, the recoupment policy for providers in the Blue Essentials, Blue Advantage HMO, Blue Premier and HealthSelect networks will be updated.

The following changes are being implemented:

• Currently, the refund request letter may be sent at a later date when the claim relates to Blue Essentials, Blue Advantage HMO or Blue Premier accounts and transactions that are excluded from the requirements of the Texas Insurance Code and other provisions relating to the prompt payment of claims as indicated in Section F - Filing Claims in the Blue Essentials, Blue Advantage HMO, and Blue Premier Provider Manual. The following additional exclusion is being added:
  • Overpayments due to a settlement or a finding of medical malpractice or negligence that does not occur within the 180 days.
• Refund requests resulting from settlement or a finding of medical malpractice or negligence shall be due within 5 business days, and absent a mutual agreement, BCBSTX will recover the full amount by offsetting current claims as described in this Refund Policy.

If you have any questions regarding these changes, please contact your Provider Network Representative.