Name of Manual - Blue Cross and Blue Shield of Minnesota

Reimbursement / Reconciliation
Field Descriptions A brief explanation of the fields on the Accounts Receivable
Recoupment Report follows:
Name — Name and address of the billing provider.
Page — Page number of the report.
Date — This date coincides with the Statement of Provider
Claims Paid. The information found on this report reflects the
activity which occurred on the Statement of Provider Claims
Paid with this same date.
NPI — National Provider Identifier.
Recovery Date — Credit activity may take place during the
week but actual transactions are not processed until Friday.
This date will reflect the Friday’s date prior to the date of your
“Statement of Provider/Institutional Claims Paid.”
Sub-ID — Member identification number under which the
credit claim activity occurred. If amounts are being recouped
due to a settlement of which you were previously notified.
Patient Name — Name of the patient.
Claim Number — Number of the claim which was overpaid
or paid in error by us.
Date Created — Actual date the claim was adjusted by us.
Service Date – Date of service on the claim.
Credit Amount — Amount we need to recover from this
claim. If we were unable to recoup the entire amount of the
claim from previous statements, this amount will list just the
balance remaining.
Amount Recovered — Amount being recouped on this
statement. This amount is deducted from the Net Payment on
the “Statement of Provider/Institutional Claims Paid.”
Balance Due — Amount we still need to recoup from future
statements. If there is a balance, the claim will be listed in
future reports when it is recouped.
Total Credit Activity — Amount of overpayment identified
prior to amounts recouped in this statement.
Total Recovered — The total amount of overpayments
deducted from your weekly Statement of
Provider/Institutional Claims Paid for the week.
Balance Due — If the overpayment exceeds what we are
recouping for that statement, the amount still due to us will be
listed here.
9-14 Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (11/02/11)