Medicare AdvantageAdministrativeMedium impact
MAPAP253 - Cost Share Refund - New
Blue Cross of Idaho·ID·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Blue Cross of Idaho implemented a new policy requiring providers to refund members any cost share amounts that were mistakenly collected or are no longer the member's responsibility after claim reprocessing. The insurer will conduct quarterly audits and may involve their Special Investigations Unit if providers fail to issue appropriate refunds.
Action Required
Immediately: Billing team must establish a process to track and refund patients when claims are reprocessed and member cost share liability is reduced or eliminated. Monitor for quarterly audit requests from Blue Cross of Idaho and be prepared to provide verbal confirmation of patient refunds. Failure to refund patients may result in investigation by the Special Investigations Unit.