Do Providers Dispute BCBS Payments? Really? Which Ones?

Blue Cross Blue Shield has more contracted providers in-network than the beach has sand. So what’s the problem?

Blue Cross and Blue Shield of Texas (BCBSTX) supports our group customers by handling the 30-day provider negotiation process. If the negotiation step does not resolve the dispute, BCBSTX also handles the IDR process for our customers as well.

Starting April 25, 2023, groups will begin seeing charges for these negotiation and arbitration processes on their invoice. Charges on the April bill will include disputes beginning on or after Sept. 1, 2022.

Dispute Negotiation Fees
This is a $50- per-claim charge for our handling of the 30-day, provider-initiated negotiation process. This charge is for our full-service approach representing the health plan and handling the negotiation with the provider. Our team’s experience is utilized to our customer’s benefit, as our claim experts can pull relevant data specific to the disputed claim and utilize it in the administration of the negotiation process.

On the bill, multiple instances of these negotiations may be batched into the same date/charge.

IDR Dispute Fees
Sometimes the 30-day, provider-initiated negotiation process does not yield a successful payment agreement. If a provider is not satisfied, they may initiate the federal IDR process. In these instances, BCBSTX will again represent our customers in the federal IDR process to ensure their compliance with the regulatory requirements and utilize our claims experience to secure the best outcome for our group customers.

If the provider initiates the federal IDR process, an additional $75-per-claim charge will be included on the bill. These charges will be combined with the negotiation fee, so individual claims going to IDR will appear as a $125 charge (combining the $50 negotiation fee and $75 dispute fee). Note, there may be some variance for batched claims.

SOURCE: ASO Group Billing and Fees for Provider Negotiation and Independent Dispute Resolution (IDR) Processes | Blue Cross and Blue Shield of Texas (