Blue Cross Blue Shield of North Dakota (BCBSND) wants to inform providers of two mass adjustments that will take place for two specific scenarios.
To remain in compliance with the administration of our contracts, adjustments will apply to Commercial, Medicaid Expansion (ME) and the Federal Employee Program (FEP) plans. Below is additional information.
It was identified that our claim system was rounding miles to the whole mile for ambulance mileage rather than pricing based off the reported fractional mileage. This caused incorrect overpayments on ambulance mileage services.
This issue has been fixed across the board. Adjustments will occur for impacted claims with dates of service between Apr.14, 2022, through Apr.14, 2023. Please wait until Feb.13, 2024, to check the status of a claim if you have not seen it adjusted on your remittance. If you feel you have any claims that may have been missed after Feb. 13, 2024, contact the Provider Services phone number.
Quarter Two Injectable Reimbursement
Reimbursement tables were loaded with incorrect contracted payment rates, causing claims to overpay for impacted codes. Corrected rates were loaded, impacted claims identified, and a recovery submitted to correctly pay according to contracted fee schedules. This only impacted claims from May 1, 2023, through May 31, 2023. Please wait until Feb.11, 2024, to check the status of a claim if you have not seen it adjusted on your remittance. If you feel you have any claims that may have been missed after Feb.11, 2024, contact the Provider Services phone number.
For both scenarios, providers will receive new remittances with processing details once identified claims are adjusted.
Contact the Provider Services phone number on the back of the ID card.