Preferred Site of Care Claim Adjustments for Blue Advantage HMOSM and Blue Advantage HMOSM Plus Retail Members

November 1, 2018

We recently discovered that some Blue Advantage HMO and Blue Advantage Plus members had some outpatient diagnostic claims underpaid. The affected claims were for diagnostic services such as labs, X-rays and high-tech radiology at professional settings between Jan. 1 and Sept. 17, 2018.

BCBSTX began reprocessing impacted claims on Sept. 17, 2018. Once the adjusted claims are finalized, patients will receive updated Explanation of Benefits statements. Providers may receive additional payments and updated Provider Claim Summary or Electronic Remittance Advice reports. Providers who collected coinsurance and copayments at the time of service may owe refunds to patients who paid too much out of pocket.

We thank you for your patience and apologize for any inconvenience. If you have any additional questions, please contact Provider Customer Service at 1-800-451-0287.