12/28/2022

Empire BlueCross BlueShield-Overpayment from 2019

I have recently gotten a request from Empire BlueCross to return money they say is from overpayment from 2019. They say that claims were processed and paid using incorrect rates. They do not explain anything, just telling me there is an overpayment of an amount per each individual claim. Some claims are for simple E?M visits and some have additional services involved. How do i dispute this request if Empire does not tell me how they arrived on the overpayment.

To dispute this request, the fee schedule that was in effect that should be included with your participating provider contract should be reviewed. If a copy of the fee schedule is not available, a duplicate copy can be requested from the provider representative to validate the recoupment requests are accurate. Once the fee schedule is reviewed, if it is determined that the recoupments are incorrect, the claims in question should be appealed or disputed with any instructions from the demand letter. If the adjustments are valid after reviewing the fee schedule, the adjustments should be allowed to be done as an offset from future claim payments.