Important Changes Impacting Claim Refunds for Blue Cross Medicare Advantage Plans

May 26, 2017

Blue Cross and Blue Shield of Texas (BCBSTX) previously announced some changes that became effective Jan. 1, 2017, as part of an initiative to improve efficiencies in claim-related processes for Blue Cross Medicare Advantage (PPO)SM and Blue Cross Medicare Advantage (HMO)SM member claims.

This month, we're following up with a clarification and changes regarding refunds:

Blue Cross Medicare Advantage (PPO) & Blue Cross Medicare Advantage (HMO) Overpayment Recovery

A new process was implemented for overpayment recovery on claims processed after January 1, 2017.

  • The Electronic Refund Management and Claim Inquiry Resolution tools on Availity will no longer be available for government programs claims.
  • Request for refund letters will be sent by mail for all providers.
  • Please review your refund letter closely and remit your refund to the address indicated on the letter.
  • If you identify an overpayment and wish to send a voluntary refund, please use the following grid to determine the appropriate address:

  • Original Claim Check Date Send to Address for Refunds
    Check date prior to 1/1/17 Health Care Service Corporation
    P.O. Box 731431
    Dallas, TX 75373-1431
    Check date 1/1/17 or after Health Care Service Claims Overpayment
    29068 Network Place
    Chicago, IL 60673-1290
  • In the event that you are unsure about the original payment date, please send payments to:

  • Health Care Service Corporation
    P.O. Box 731431
    Dallas, TX 75373-1431