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Preferred Site of Care Processing Issue for Blue Choice Preferred PPOSM Members

Posted October 18, 2018

We discovered that some of our Blue Choice Preferred PPO members had outpatient diagnostic claims underpaid. The affected claims were for diagnostic services such as labs, X-rays and high-tech radiology at professional settings between Jan. 1, 2018, and Sept. 17, 2018.

Blue Cross and Blue Shield of Illinois (BCBSIL) began reprocessing impacted claims on Sept. 17, 2018. Once the adjusted claims are finalized, patients will receive updated Explanation of Benefits statements.

Providers may receive additional payments and updated Electronic Remittance Advice or Provider Claim Summary reports. Providers who collected coinsurance and copayments at the time of service may owe refunds to patients who paid too much out of pocket.

We thank you for your patience and apologize for any inconvenience.