Medicare Advantage (MA) Bad Debt Hospital Settlement for In-Network Providers

Medicare Advantage
Policy Number: MA-X-071 

Last Updated: Nov. 20, 2024

Bad debt settlements include both inpatient and outpatient claims for Blue Cross and Blue Shield of Nebraska (BCBSNE) Medicare Advantage members. All other outpatient reimbursement issues should be referred to your BCBSNE Provider Executive.  

BCBSNE reimburses Bad Debt claims for only uncollected BCBSNE Medicare Advantage member liability. Charges for non–covered services are not included. The hospital must provide a signed attestation that defines and calculates its bad debt numbers in accordance with the CMS rules and guidelines. The Provider should provide documentation of attempts to pursue payment; these copies must include dates the requests (at least two) were sent to the member(s), along with an attestation, all information should be provided upon receipt of the request for settlement.  

The hospital must request a settlement from BCBSNE in writing within 180 days of the hospital’s fiscal year-end, and must include all of the following information: 

  • An overview of the request 
  • An estimate of the impact (this should include what the member owed, paid and outstanding) 
  • Supporting documentation of two collection efforts made by the provider to each member 
    • Proof of attempts to pursue payment may include the following: 
      • Copies from your system that were sent to members with dates 
      • Monthly invoices sent to members 
      • Spreadsheet of attempts are not acceptable 
  • A detailed listing of the impacted members including DOS, cost share/copayment amounts; amounts collected; amounts outstanding 
  • BCBSNE reserves the right to research (via member) to confirm member did not pay 

The hospital can submit this bad debt settlement request with the required documentation to ProviderExecs@NebraskaBlue.com

BCBSNE reviews the information and gives a written determination of funds owed the provider from BCBSNE or funds owed BCBSNE from the provider. Payment of the settlement will be due by either party, within 60 days after final terms of the settlement are agreed upon.