The following information does not apply to government programs (Medicare Advantage, Illinois Medicaid). It is provided as a general resource to providers regarding the overpayment recovery process that may be available for commercial claims. Participating providers should refer to their participating provider agreement and applicable provider manual for additional information.
The Payment Recovery Program (PRP) allows BCBSIL to recoup overpayments made to BCBSIL contracting facilities and providers when payment errors have occurred. Overpayments may be identified by BCBSIL and/or the provider.
Examples of overpayment reasons include:
- Claim was paid incorrectly, as per the provider’s contract
- Provider posted a credit for supplies or services not rendered
- Provider cancelled charge for any reason
- C.O.B. Credit or Duplicate Payment received by provider
- “Not our Patient” – Payment received by provider that did not render services
- Medicare Eligible or Workers Compensation payment already received