Preferred Site of Care Claims Processing Issue for Blue Advantage PPOSM and Blue Preferred PPOSM Members
We recently discovered that some Blue Advantage Bronze PPO and Blue Preferred Bronze PPO members had 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.
Blue Cross and Blue Shield of Oklahoma 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.