Speech Therapy Claims Issue

March 4, 2022 Update: As previously acknowledged, some providers received a duplicate payment in error. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has a standard process to send recoupment letters for any overpayments that haven’t been reconciled within 80 days. Our standard process to distribute these letters continued after we told providers not to return the overpaid funds. We should have stopped this process or provided more information about what to expect, and we didn’t. We are truly sorry for the stress and inconvenience this has caused our valued providers.

Although letters state we will begin collections activity, we assure you that we will not. As previously stated, if you received a duplicate payment, you do not need to send us the overpaid funds. The overpayment will be recouped from future claims.

We are doing everything possible on our end to rectify this situation and we apologize that this issue has continued.

Dec. 22, 2021 Update: Some providers may have received a duplicate payment for speech therapy claims. If you received a duplicate payment, please keep the funds. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will update your account, so that any extra payments will apply toward future claims. 

Dec. 20, 2021 Update: Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is pleased to report that almost all of the erroneously reprocessed speech therapy claims have been corrected, and providers will begin seeing claims payment adjustments today. We expect the remaining claims to be fixed by the end of the year. Thank you for your patience.

Recently, we learned about an issue with certain speech therapy claims that were reprocessed. After immediately investigating, we learned that we made an incorrect benefit change in our system that caused claims to reprocess in error. This system change incorrectly caused speech therapy claims to be considered non-covered for members with certain diagnoses. 

Because of this error, many speech therapists received notifications from us that previously paid claims are being denied for coverage, and that Blue Cross NC is seeking a recoupment of funds for those claims. 

Also, families who visited out-of-network speech therapists received notices from us about recoupment of funds for these claims. 

This issue affected customers of both fully-insured and Administrative Services Only (ASO) commercial health plans. It does not apply to our Federal Employee Program, Medicare or Medicaid customers.

We are truly sorry for any stress and inconvenience this caused many of our providers and customers. Please be assured that families and providers are not responsible for the cost of speech therapy claims that we recently reprocessed incorrectly.

Moving forward speech therapy claims for attention deficit disorder, behavioral problems, conceptual handicap, mental retardation, psychosocial speech delay and developmental delay diagnoses will continue to be covered for members.  

We are taking the following actions immediately

• We’re working as quickly as possible to correct our systems, so that speech therapy services are covered for members with any of the diagnoses above. These corrections will apply to all claims that were recently reprocessed in error, as well as claims for future dates of service.
  • A small number of new claims may process incorrectly while we work to make these updates. Please rest assured that once our systems are updated, previously denied claims affected by this issue will be automatically adjusted.
  • In order to ensure current claims pay appropriately, we are holding some claims payments until the necessary coding, reconfiguration, and testing work is complete. 
• We are beginning to reach out with additional clarification to providers.
• We are fixing any incorrect information on our website.
• We are providing the current medical policy for your reference.

The health and well-being of our members is always our number one priority, and we are diligently working to correct and communicate this information. 

If you have questions, please call our Provider Blue Line℠ at 800-214-4844 for assistance.