Refund Requests

BCBSNE will not initiate refund requests beyond the time specified in the applicable Provider Agreement except in specific situations. No refund time limit will apply when the refund initiation is based on a reasonable belief of fraud, abuse or other intentional misconduct; if required by a state or federal government program or if another payor is involved (e.g. coordination of benefits, subrogation or right of reimbursement, and workers’ compensation coverage).

Beginning June 1, 2021, internal initiated adjustments will have an overpayment threshold of $40.00. Adjustments will not be made unless they exceed the $40.00 threshold. This applies to dental, Medicare supplement, local and FEP claims.