Required Documentation for Processing Provider Refunds

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has received an influx of provider refund submissions without the required documentation, resulting in the refund being returned to the provider. Without the necessary documentation, including the completed Provider Refund Return Form (PDF) and a clear copy of the Explanation of Payment (EOP), Blue Cross NC must return the refund to providers for resubmission with the required information.

The documentation received often lacks essential details such as claim number, EOP, subscriber ID, and reason for the refund to Blue Cross NC.  We want to emphasize the importance of completing the refund form in its entirety, providing a reason why the refund is being submitted and providing supporting documentation.  If the required information is not provided, this creates processing delays, returned mail with a returned check to the provider requesting additional information, and administrative burden on the provider and Blue Cross NC.

The following are specific examples of inaccurate provider refund submissions and the required documentation needed.

• Corrected claim forms must specify changes to lines, charges or procedure codes.
  • Include ALL services to be considered for payment when submitting a corrected claim.  This includes services that may have already paid on the original claim submission. Please note: When filing a corrected claim, submit all charges and procedures that were on the original claim rather than just the correction(s) you are submitting. If you only submit the correction(s) that must be submitted, it will appear that you intend to remove all previously processed charges and a refund will be requested for previously paid amounts.
• For Workman’s Compensation or auto liability cases, supporting forms are mandatory.
• For third-party billing, including a copy of the EOP, reason for refund, and supporting documents is mandatory.
• When sending a refund due to Other Insurance, include the Other Insurance EOP.
• For total void refunds, always issue a full refund. In cases of duplicate claims/payments, include all EOPs showing duplicate payments.
• Providers are reminded to return refunds to the correct payee, always sending them to the plan that originally paid the claim.

If you have any questions, please call the Blue Cross NC Provider Customer Service Line 800-214-4844.