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Overpayments should be promptly reported to Blue Cross & Blue Shield of Mississippi. Overpayments must be reported by either submission of a corrected claim or by submission of a voided claim. Refund checks should not be submitted to resolve an overpayment and beginning January 1, 2009, will be returned to the provider for submission of either a corrected or voided claim.
The methods of reporting overpayments are further defined below:
- Corrected Claim: A corrected claim should be submitted when the overpayment was created because the original claim was submitted incorrectly. Providers that are currently set up to file electronically must submit all corrected claims electronically. Medical records documentation must support all corrected claims. See below for examples of when to submit a corrected claim for an overpayment:
- Original claim filed with an incorrect diagnosis and/or procedure code.
- Original claim filed with an incorrect charge amount for a service.
- Original claim filed with incorrect units.
- Original claim filed with the incorrect primary payment information. (Primary EOB is not needed.)
- Original claim filed under an incorrect provider number.
- Voided Claim: A voided claim should be submitted when the overpayment was created due to the provider receiving of duplicate payment or the entire claim was filed in error. Providers that are currently set up to file electronically must submit all voided claims electronically. See below for examples of when to should submit a voided claim for an overpayment:
- Original claim was filed in error.
- Original claim filed under an incorrect patient.
- Duplicate payment received for the same services.
- Services were work related and original claim should have been filed to Workers’ Compensation.
- Charges have been paid in full by a third party liability insurance carrier.
For more information about how to submit corrected or voided claims electronically, please refer to either the Professional Claim Filing Guidelines or the UB04 Claim Filing Guidelines located under the Electronic Solutions section.
Please note that in certain situations, it may be determined by Blue Cross & Blue Shield of Mississippi that a refund check is required for an overpayment. In these situations, Blue Cross & Blue Shield of Mississippi will send notification to the provider’s office to request a refund check. The notification will include specific mailing instructions.
Beginning January 1, 2009, only refund checks requested by Blue Cross & Blue Shield of Mississippi will be accepted. Any other overpayment refund checks will be returned to the provider’s office for submission of a corrected claim or a voided claim.
Providers that do not currently file claims electronically but wish to enroll to file claims electronically should contact EDI Services by email at firstname.lastname@example.org or by phone at (601) 664-4357 or (800) 826-4068 for additional information.