Name of Manual - Blue Cross and Blue Shield of Minnesota

Questions and Answers 1. Where will adjusted claims appear?
Reimbursement / Reconciliation
They will appear as claim transactions on the remittance
advice. You will see negative amounts on the cancel of the
original claim followed by a new claim to show the final status.
2. How can I identify adjustments in the remittance?
The claim number will be the same as in the original statement,
except the last three digits. For example: If the original claim
ended in 000 the adjusted claim will end in 010. If it needs to
be adjusted again, it will end in 020, etc. If we then make
additional or adjusted payment for that claim, the newly
processed claim will be printed above the original claim.
3. What is a credit balance?
When the amount of this payment is not enough to cover the
credits, a credit balance will occur. If the credit balance
occurred on this statement, this amount the will appear in the
PDF version of the remit in field #27 along with a code in field
#28. If there were credit balances from previous statements,
that information will be reflected in fields #27 and #28. An
Accounts Receivable Recoupment Report is sent separately
and prior to the remittance reflecting which claims are being
recouped in this statement period. This report is only sent when
recoupments will be made.
A credit for a Blue Plus member will only be recouped from
the Blue Plus remittance and a credit for a Blue Cross member
will only be recouped from the Blue Cross remittance.
4. How do I use the Accounts Receivable Recoupment Report?
This report is sent out under separate cover from the weekly
remittance and lists the claims that will be recouped that week.
The amount listed on this report will be reflected in the weekly
remittance. Remember to keep this report in a central location
for easy retrieval.
5. Do I have to credit the member’s account based on the
Accounts Receivable Recoupment Report?
If you already credited the member’s account based on the
remittance that reflected the adjustment, then do not adjust the
member’s account again. This is an internal workflow for your
office. Adjusting the member’s account using both the weekly
remittance and the Accounts Receivable Recoupment Report
may result in duplication.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/02/11) 9-7