Blue Cross/Blue Shield of Illinois (BCBSIL) has advised United of a claims processing error affecting Members enrolled in the traditional PPO Medical plan.
The error occurred when the monthly process of updating the year-to-date accumulators, that is deductibles and out of pocket maximums, did not run as intended for the month of September. Because of this system failure, all accumulators (e.g. deductibles) were reset to zero ($0) as of September 1. Resetting this value to zero indicates to the system, incorrectly, that the employee has no dollars accumulated toward her/his deductible or out of pocket maximum. Some claims have been paid incorrectly. Once this issue was identified, BCBSIL put a hold on the Traditional PPO to “pend” incoming claims and stop them from processing incompletely.
We are learning a maximum of 812 AFA Members have been impacted by this issue. BCBSIL will now begin to reprocess the claims received from September 1 – September 21 (the hold date) and will update the accumulators.
The next step in BCBSIL’s process is to ensure communication is sent to the affected employees to ensure they understand the process for the overpayments that may have been made to providers. A targeted communication explaining this process is planned for distribution to affected employees by the end of this week.
Employees having questions should contact Blue Cross/Blue Shield directly or their Local Council Office for assistance.