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System Fix for Surgical Procedure Overpayments

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is working to resolve a technical system issue causing the overpayment of claims reporting surgical procedures when units greater than one are filed. The issue is limited to claims processed for Blue Cross NC’s under age-65, individual and small group members. Not all claims reporting multiple units on surgical procedures for these members are affected.  

At this time, we understand the technical fix needed, and an interim manual process has been implemented to prevent further overpayments from being issued. This manual process began on September 20, 2017.  

Queries of processed claims are currently being performed to locate the claims for surgical procedures reporting units greater than one, which resulted in overpayments being issued. These queries review claims processed over the last 24 months, and claims identified to have been issued overpayments will be adjusted, and we will request refunds in accordance with providers’ contractual agreements. 

If your practice received an overpayment for surgical services provided and has not already refunded the overpaid amount, please anticipate our refund request(s) to arrive early in October. We’re asking providers to please not initiate refunds for overpaid units on surgical procedures until you receive our refund request(s).  

Please understand the interim fix is a manual process, and potentially a small number of claims might overpay until the permanent system fix is installed. We expect this to be completed in November.  Because of the potential for additional overpayments, we will continue our claim querying until the permanent system fix is in place.  

We apologize for any inconveniences this technical system issue creates for you, and we appreciate your ongoing patience as we continue our work to resolve it. If you have questions or need assistance with an overpayment on a claim reporting surgical procedure units, please contact Customer Service, at 1-800-214-4844.