Understanding Subrogation EOP Messaging

Providers may have encountered situations where their patient may have been involved in an auto accident or other incident and one or more liability carriers are responsible for payment of the patient’s treatment. The Rawlings Company (Rawlings) is Blue Cross and Blue Shield of North Carolina’s (Blue Cross NC) subrogation recovery vendor and pursues the responsible 3rd party liability payer for payment of the treatment that was billed to, and paid by, Blue Cross NC.   

When Rawlings recovers and receives the payment from the 3rd party liability payer, the recovered funds are sent to Blue Cross NC for processing against the related claims.  

This recovery automatically triggers an updated Explanation of Payments (EOP) to notify the provider of the shift in monetary responsibility from Blue Cross NC to the at-fault insurance. By law, Blue Cross NC must alert you to the adjustment and shift in liability. The common reason codes for a subrogation recovery are typically ESS, E32.5 or WK4. 

The updated EOP shows a negative adjustment crediting Blue Cross NC, followed by a positive adjustment, indicating the payment by the 3rd party liability payer. However, the negative adjustment is often misunderstood as a voucher deduction even though the provider account remains balanced.  Please be advised that this does not indicate a voucher deduction and the provider should not balance bill the Blue Cross NC member.  

If you have any questions regarding the EOP, please contact our Provider Blue Line℠ at 800-214-4844.