Name of Manual - Blue Cross and Blue Shield of Minnesota

Reimbursement / Reconciliation
Questions and Answers
(continued)
6. What if there is a claim on my remittance for a patient that
is not ours?
Request an adjustment by contacting provider services. Please
do not send our payment check back to us or send us a refund
check unless we have requested it from you.
7. Why does the check I received not match the amount listed
under Net Payment Activity on the statement?
Less Prior Credit Balances and Less Current Credit Balances
will be subtracted from the Net Payment Amount. Your check
should match the amount listed in the Payment Due field on
the statement.
8. What can I bill the patient and how can I identify it on the
statement?
The Patient Responsibility field reflects the total patient
liability. This is the amount that the patient is responsible to
pay. However, you may have already billed the member for
copayments up front.
9. What do I have to write-off and how can I identify it on the
statement?
The group code 'CO' signifies a provider contractual
obligation. Any amounts associated to the use of this code
should be written off.
10. Do members receive their Explanation of Health Care
Benefits (EOB) at the same time as providers?
No, the member’s EOB is mailed daily and provider’s
remittances are sent or posted weekly. However, we mail
members’ EOBs monthly if there is zero member liability and
payment was made to the provider. If a member references a
claim that you haven’t received notice on yet, it should be on
your next remittance.
11. How can I identify BlueCard ® claims?
The BlueCard claims may be identified by the three digit
alpha-prefix on the member’s identification number. BlueCard
member's prefix will not be XZA.
9-8 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/02/11)