Tuesday, July 18, 2017
Update: Explainer on Blue Shield/Blue Cross Mix-Up
Here is a further explanation from a reliable source:
Some of our Medicare members continue to receive Explanation of Benefits (EOBs) from Blue Shield of CA (denials) for claims incurred in 2017. The reason for this is due to CMS/Medicare’s “crossover” process, by which the claimants’ secondary plan (such as the UC Medicare PPO and High Option plan) receives claims directly from CMS once Medicare has adjudicated the claim. CMS is informed of the retiree’s supplemental plan via an electronic feed from the carrier. Unfortunately, CMS still has Blue Shield’s crossover in place and Blue Shield has not been able to correct the information electronically.
Therefore, Blue Shield is manually updating UC retirees’ records to correct the crossover and anticipates these updates will be completed by next week. After that, CMS will still have to update their system which usually takes about 2 more weeks, after which the issue will be resolved.
The good news is that Medicare also has Anthem’s crossover in place (along with Blue Shield’s) so the 2017 claims are being processed twice – once under Anthem where the claims adjudicate correctly and also under Blue Shield where the same claims are (correctly) denied. The result is that two EOBs are sent to the member, causing confusion and concern. To date, there are 947 members affected.
If you receive a call from a member about this, please share with them that claims are being sent to both Blue Shield and Anthem now and that Anthem is processing these claims correctly. For 2017 claims, members should disregard the Blue Shield denial EOBs.
Anyway, if you are getting stuff from Blue Shield, now you know how to deal with it: