Duplicate submissions of a claim, examiner-coding errors, coordination of benefits (COB) issues, and/or incorrect payment levels may result in overpayments.
In the event Blue Shield pays the provider and it is discovered that payment was issued in error, Blue Shield will request a refund of the overpayment within 365 days of the original payment date.
Blue Shield's refund request will be issued to the provider in writing, and will at a minimum, include the patient's name, the date of service, the claim number (ICN) and an explanation of the overpayment.
Within 30 working days of receipt of the refund request, the provider must issue a refund or notify Blue Shield that they disagree with the request. Providers, who disagree with the refund request, must send a written notice to Blue Shield, within 30 working days of the date the refund request was received.
The notice appealing the refund request should clearly state the reasons the provider believes the original payment was correct. If the provider does not appeal the refund request within 30 working days, or as otherwise agreed to within the contract, Blue Shield will pursue the refund and may offset the account or assign the account for recovery.
Overpayments from Blue Shield are to be directly refunded to Blue Shield. When requested, send refund checks to:
Blue Shield of California
Attn: Cash Receiving
P.O. Box 241012
Lodi, CA 95241
If a provider believes an overpayment was issued because Blue Shield paid the claim as primary in error, he/she should send the appropriate service center a notice of overpayment along with a copy of the EOB from the primary carrier.