The Blue Cross Blue Shield Settlement Billing Dispute External Review Board (BDERB) is now operational and available to MDs and DOs who are class members (and did not opt out) of the Love, et al v. BCBSA, et al. Settlement dated April 27, 2007. Physicians (and physician groups) may file billing disputes with BDERB either online or via fax/mail by visiting http://www.hmosettlements.com/pages/bluecross.html. Below are the BDERB billing dispute instructions and the billing dispute form.
MES - BDERB Instructions
BDRP Provider Request Form
The Settlement Fund
As part of the Settlement, the Blue Parties’ have agreed to make a settlement payment of $131,209,507 which, together with interest from June 30, 2007, will be distributed to Physicians who are Class Members and who timely file a Claim Form. If the Settlement is approved by the Court, these Class Members will be entitled to payments from the Settlement Fund in accordance with formulas that are set forth in the Settlement Agreement.
“Class” means any and all Physicians, Physician Groups and Physician Organizations who provided Covered Services to any Plan Member or services to any individual enrolled in or covered by a Plan offered or administered by any defendant or by any other primary licensee of the BCBSA or by any of their current or former subsidiaries or affiliate, from May 22, 1999 through May 31, 2007. The Class excludes persons who execute a timely Opt-Out from the Class.
A Physician who provided any Covered Services since May 22, 1999 but who has since become an inactive physician, retired from practice, or otherwise ceased to practice, or has died as of May 31, 2007 (“Retired Physician”) will receive a pro rata portion of the amount of the Settlement Fund that has been allocated to Retired Physicians.
Formula for Actively Practicing Physicians
The formula is based on Gross Receipts for the calendar years 2004, 2005 and 2006 for providing Covered Services to the Plan Members of the settling Blue Plans as follows:
|Active Physicians whose aggregate Gross Receipts were zero or less than $5000
(determined pro rata according to the $5,000 claims that are filed)
|Active Physicians whose Aggregate Gross Receipts are at least $5,000 but less $50,000
|| 5 x Base Amount
|Active Physicians whose Aggregate Gross Receipts are $50,000 or greater
||10 x Base Amount
The settling Blue Plans are listed in the notice.
In determining Gross Receipts physicians should include amounts paid directly by the settling Blue Plans or by intermediaries for providing Covered Services to the settling Blue Plans’ Plan Members. For example, a Physician may have provided services through an intermediary such as an IPA that contracted with a Blue Plan to provide services.
Class Members may elect to have the amount of their settlement payment contributed on their behalf to a charitable organization set forth on page 4 of the Claim Form Instructions. The charitable organization sponsored by MSSNY is the Medical Educational and Scientific Foundation of New York, Inc.
Further information is available at the following websites:
List of Plans Participating in the Settlement
Settlement Compliance Dispute Form
Step By Step Guide to Filing a Settlement Compliance Dispute
Settlement Implementation Dates
The Settlement Administrator may be contacted by telephone at 1-877-893-2643.