Update for Electronic Funds Transfer (EFT) Recipients
On May 12, 2016, Blue Cross and Blue Shield of Texas (BCBSTX) experienced an internal system issue that affected certain providers who are currently enrolled and/or are receiving claims payments via EFT. As we announced on May 13, 2016, this system issue may have caused an erroneous credit to be applied to your bank account. BCBSTX has taken steps to resolve this issue as quickly and efficiently as possible. Additional information is included below.
How can providers tell if they were affected?
Look on your bank statement for the EFT payment date – the same check number/amount will appear twice on May 12, 2016. On the Electronic Remittance Advice (ERA), the Check or EFT Trace Number will appear in the TRN02 segment. You can also review the Electronic Payment Summary (EPS) for claim payment details and/or use the AvailityTM Remittance Viewer.
What is BCBSTX doing to resolve the issue? What are the next steps?
BCBSTX will be debiting affected provider bank accounts beginning May 16, 2016, for all erroneous credits, in accordance with section 1.2 of the EFT Agreement. Debits will be reflected on the provider’s bank statement on the day following the transaction. For provider accounts that cannot be debited, BCBSTX will follow the guidelines of the Payment Recovery Program (PRP). The PRP allows BCBSTX to recoup duplicate payments made to contracted facilities and professional providers.*
What should providers do right now, if anything?
- Review your bank statement and/or ERA/EPS to gain awareness of erroneous credits. Please do not move or withdraw the erroneous credits from your accounts.
- If you use the ERA for auto-posting to your patient accounting system, check with your billing service or clearinghouse – most software vendors have controls in place to remove duplicate auto-postings. (Smaller provider offices may have to adjust manually to back out additional payments.)
- Look for discrepancies between your EFT and ERA and contact our Electronic Commerce Center immediately at 800-746-4614 if there are issues.
We thank you for your patience and apologize for any inconvenience this issue may have caused.
*As a reminder, the PRP process is as follows: A refund request is sent via our Electronic Refund Management (eRM) tool. Providers not using eRM will receive a refund request letter. If no action is taken by the provider within the allotted time frame, BCBSTX will recover the duplicate payment by offsetting current or future claim payments. The recovery details will appear on the ERA/EPS or Provider Claim Summary (PCS).
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSTX. BCBSTX makes no endorsement, representations or warranties regarding any products or services offered by third party vendors such as Availity. If you have any questions about the products or services offered by such vendors, you should contact the vendor(s) directly.
