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Recoupment Letter Threshold for Government Programs Claims, Effective July 31, 2020

Posted May 26, 2020

Effective for claims processed on or after July 31, 2020, Blue Cross and Blue Shield of Illinois (BCBSIL) will implement an overpayment recovery threshold for government programs claims. This includes claims submitted to BCBSIL for services provided to our Blue Cross Medicare Advantage (PPO)SM, Blue Cross Medicare Advantage (HMO)SM, Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Community Health PlansSM (BCCHPSM) members. The threshold process will flag individual claims with overpayments less than $5. Request for refund letters will not be generated or mailed, and no balances will be recouped, when the original overpayment is less than $5.