Advanced Payments Program FAQs
Q1. What is the Advanced Payment Program?
A. The Advanced Payment Program provides support to BCBSKS contracting providers who may be impacted financially by the COVID-19 pandemic. The program was created to provide contracting providers in our service area assistance with cash flow during the COVID-19 pandemic. Payment dates will be May 18 and June 15. Providers must apply to receive payment. The application will be available May 4 and the deadline to apply is May 8.
Q2. Are all providers eligible for the advance payment?
A. Not all providers are eligible. BCBSKS contracting professional and institutional providers within the BCBSKS service area must meet ALL of the following requirements:
- In good contract standing and have submitted claims within 180 days before the date of request
- Not in bankruptcy
- No outstanding delinquent overpayments
- Have a net BCBSKS revenue decline of at least 30 percent during the past 30 days
- Not a medical equipment provider/supplier; they are not eligible
Q3. How can a provider apply for the advance payment?
A. A provider must complete an application via the BCBSKS provider portal to participate. It will be available on May 4. A link to the application can be found here. E-mail covid19advancepayment-AT-bcbsks-DOT-com to request assistance.
Q4. How often will a provider receive a payment?
A. An approved provider will receive an advance payment amount calculated by BCBSKS. This payment will be made available on May 18. Providers who qualify for the May 18 payment will receive an additional payment on June 15, as long as allocated funds are available.
Q5. How long will the advance payment option be available?
A. The application to request a payment will be available through Availity beginning May 4. The deadline to apply is May 8.
Q6. Does a provider need to apply by a certain date to participate?
A. Yes. A provider will need to complete an application by May 8 and submit a signed repayment agreement to covid19advancepayment-AT-bcbsks-DOT-com on or before May 13 to participate in the program.
Q7. Will BCBSKS automatically send advance payments to providers?
A. No. Providers must apply and qualify for advance payment.
Q8. Can a provider opt out?
A. This is a voluntary program and providers will not be eligible for the program unless they apply and are approved.
Q9. How will BCBSKS determine if a provider qualifies financially?
A. A provider will submit and attest to the following information within the application:
- Average net revenue from BCBSKS in January and February
- Net revenue from BCBSKS within the past 30 days
- Any expected additional net revenue from BCBSKS that is yet to be billed or paid in the last 30 days (can be an estimate).
These amounts will be used to calculate the net revenue percentage decrease to determine provider eligibility.
Q10. What was the methodology used to calculate the advanced payment?
A. BCBSKS reviewed total claims paid during the 2019 calendar year and calculated the average amount paid per month. The 2019 average monthly paid amount was multiplied by 15 percent to determine the advance payment amount.
Q11. Is there a minimum amount that BCBSKS will remit to providers as an advance payment?
A. Yes. The advance payment needs to calculate to at least $500 in order to be processed.
Q12. Is the advance paid at a provider level or practice level?
A. Advanced payments will be based and paid on the provider’s billing NPI number.
Q13. Does a provider have to repay the monthly advances?
A. Yes. BCBSKS will deduct 16 equal, weekly amounts where the sum is equal to the payments made from BCBSKS in May and June. The repayments will be electronically withdrawn from the provider bank account beginning in November 2020 and ending in February 2021.
Q14. Will the payments be recouped from future BCBSKS payments?
A. BCBSKS does not intend to recoup the payments from future claims payment. However, if a provider fails to reimburse BCBSKS per the signed agreement, BCBSKS reserves the right to reduce claims payment to recoup monies owed by the provider.
Q15. What happens if a provider files bankruptcy before the full advanced amount is repaid to BCBSKS?
A. The agreed upon repayment terms will still apply.
Q16. Will the advance payment be made on a remittance advice?
A. No. Advance payments will be separate from the EFT related to claims processing and will be made through EFT on May 18 and June 15.
Q17. Will the payments be sent via Automated Clearing House (ACH) or check?
A. Payments will be made to providers via ACH to the same bank account weekly payments are deposited.
Q18. How will a provider know how much they will have to repay?
A. The repayment agreement includes the dollar amount that will need to be repaid to BCBSKS. Repayment will begin in November 2020 and conclude in February 2021. A reminder will be sent to providers when the repayment begins which will include the dollar amount that will be withdrawn from the provider bank account weekly.
Q19. Will BCBSKS charge the providers interest on the advanced payments?
A. No. Interest will not be charged as this payment is an advance and not a loan.
Q20. Can the application for the advance be submitted via mail versus electronically?
A. Providers are encouraged to request the advance payment through their Availity log in and single sign on to BlueAccess. Providers who have difficulties with submitting the advance request online may send an e-mail to covid19advancepayment-AT-bcbsks-DOT-com to request assistance.
Q21. How is the 30% reduction in net revenue calculated?
A. BCBSKS Net revenue for the most recent 30 days +
Expected additional net revenue to be billed, or billed, but not paid by BCBSKS for the most recent 30 days =
Total BCBSKS Net Revenue for the most recent 30 days
Total BCBSKS Net Revenue for the most recent 30 days -
Average BCBSKS Net Revenue for January and February of 2020 =
Difference in revenue
Difference in revenue ÷
Average BCBSKS Net Revenue for January and February of 2020 =
Percent of BCBSKS net revenue loss
|Net Revenue for the most recent 30 days||$5,000.00 +|
|Expected additional net revenue to be billed, or billed but not paid in the most recent 30 days||$1,000.00 =|
|Total BCBSKS Net Revenue for the most recent 30 days||$6,000.00 -|
|Average BCBSKS Net Revenue for January and February of 2020||$10,000.00|
|Difference in revenue||(-$4,000) ÷|
|Average BCBSKS Net Revenue for January and February of 2020||$10,000.00 =|
|Percent of BCBSKS net revenue loss||-.4 (-40%)|
Q22. Can I receive additional clarification on the denial of my application?
A. Yes, if you would like additional clarification on your denied application, you may send an email to covid19advancedpayment-AT-bcbsks-DOT-com or you may contact your provider consultant or representative.