Update on Evaluation and Management Related Services

On April 16, 2021, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced policy changes for the reimbursement of Evaluation and Management (E&M) related services, specifically office problem visits reimbursed at 50% if performed on the same day as a preventative wellness visit. These changes were effective June 1, 2021. 

Blue Cross NC recently discovered a technical issue where our editing was not properly adjudicating the problem visit at the 50% allowance, according to the policy for claims with dates of service June 1, 2021 to May 31, 2022.  This error has been corrected and is no longer an issue for claims submitted after June 1, 2022.  As a result, some providers will receive post-payment recoupment requests to correct our overpayment of problem office visits done on the same day as preventative visits.  We apologize for the inconvenience and appreciate your understanding as we rectify past claims to align with our notice and policy cited above.   

This communication applies to the following lines of business: Administrative Services Only (ASO), fully insured membership, IPP Host, and the State Health Plan (SHP).