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Certain Telemedicine Claims to be Adjusted

A recent claim audit revealed that some claims for telemedicine services performed and processed between February 3, 2022, and March 2, 2022, did not apply appropriate member cost-sharing amounts that were reinstated effective February 3, 2022.

On June 3, 2022, we will begin adjusting impacted telemedicine claims originally processed between February 3, 2022, and March 2, 2022, to recover overpayments made to participating providers for these services. This impacts telemedicine services provided to patients enrolled in Horizon fully insured commercial plans, the State Health Benefits Program (SHBP) and the School Employees Health Benefits Program (SEHBP).

Reimbursement details, including any changes to member responsibility, will be included in the Explanation of Payment statements and member Explanation of Benefits (EOB) statements.

Reimbursement recoveries that result from these claim adjustments will establish Account Receivables (A/Rs) within our claim system. A/Rs are inactive for 45 days to allow time for physicians and other health care professionals to return overpayments to us. After 45 days, pending A/Rs will be activated to apply to future payments to satisfy the A/R amount.

We apologize for any inconvenience.

If you have questions, please call 1-800-624-1110, Monday through Friday, between 8 a.m. and 5 p.m., Eastern Time.

Published on: May 4, 2022, 11:27 a.m. ET
Last updated on: May 3, 2022, 10:11 a.m. ET