Network Error Regarding Patient Responsibility
Issue: #404 NOV2018
Blue Cross Blue Shield of North Dakota (BCBSND) wants to make participating providers aware of a system error that indicates high charges as Patient Responsibility. This error is not occurring across the board but rather when the following conditions are all met:
- Member who has migrated to the new claims processing system and
- Member has a network product such as Preferred Blue PPO (BlueCard PPO), BlueChoice, SelectChoice, etc., (where a member selects a specific provider network to seek services from) and
- Member goes to an out-of-network, BCBSND participating provider
As a reminder, participating providers agree to write off high charges and not bill the member. This remains the case and this practice should be observed despite the potential indicator on the remittance advice showing high charges as Patient Responsibility.
- Migrated Member A has the network product SelectChoice with Provider A
- Provider B is a BCBSND participating provider who is not part of the network product SelectChoice with Provider A
- Migrated Member A seeks services from Provider B
- Provider B submits a claim to BCBSND and Provider B’s remittance advice incorrectly indicates the member’s high charges as Patient Responsibility. Since Provider B is a participating BCBSND provider, the member is not billed high charges.
* A solution has been identified, once implemented, we will reprocess the claims.