Wiki When a primary insurance recoups and reprocess after timely filing

[Jessicakate1113]

I’ve always been under the impression that if a primary insurance recoups and reprocesses after timely filing, we can submit a corrected claim to the secondary showing the payment changed with the latest EOB from the primary.
My question is, the secondary is denying it stating it should have been submitted as a clean claim. I don’t think this is right and wanted to know if anyone else has run into this and if you have any resources handy that I could use to show the secondary insurance they’re wrong.
Thanks!

 

[michelleaapc2012]

I never file a "correction" with the insurance that should have been billed as primary. I submit the claim as a new claim/ clean claim with the eob from the other insurance showing recoupment. Sometimes it takes a few phone calls and even a reconsideration request to get the new insurance to pay, but I have never had one deny.

 

[Jessicakate1113]

I never file a "correction" with the insurance that should have been billed as primary. I submit the claim as a new claim/ clean claim with the eob from the other insurance showing recoupment. Sometimes it takes a few phone calls and even a reconsideration request to get the new insurance to pay, but I have never had one deny.

No, it’s not a new insurance. You know how sometimes BCBS will recoup and repay after doing an internal audit? That’s what they did.

Let’s say we have a claim from 2017 and BCBS paid $100. Now its 2019, and they recouped off our remit and repaid at $75, stating they paid at the incorrect rate in 2017. The patient had Tenncare secondary at the time, so I sent them a corrected claim with the new amount paid showing on the HCFA and the new EOB. Should I have done the corrected claim or submitted a new claim?

 

[Ahardisty]

I would say that would be a corrected claim. The only thing you may have to bring up to the secondary would be that BCBS on their own reprocessed the claim and stating that it paid incorrectly providing the proof that it was on BCBS and not you like a reconsideration. Out of curiosity, were you able to verify that what BCBS recouped was valid and if it was a self-funded plan or a fully funded plan? Because I thought the fully-funded plans had 6 months from the date of payment to request a refund? It may be different since I deal more with out of network plans then in-network.