CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Provider Guidelines for Requesting Point of Service Payment/Preservice Payment and/or Maintaining Credit Card Information

Governs when participating providers may request payment at point of service or keep members' financial card information on file and the required practices for estimating, collecting, and refunding payments; applies to BCBSRI participating providers and members under Medicare Advantage and commercial products.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyProvider Guidelines for Requesting Point of Service Payment/Preservice Payment and/or Maintaining Credit Card Information

Policy CodePolicy N/A

Change TypeNo material change

Effective DateMay 1, 2017

Next Review DateMay 7, 2024

Key ActionIf a member pays before claim adjudication, treat payment as an estimate and automatically refund any overpayment to the original payment source after remittance.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

05/01/2017effective date

07/05/2024last review

required when overpaidrefunds

not requiredCDH pre-claim payment

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Point-of-Service Payment Rules

Point-of-service payment and stored payment information criteria

Applicability and rules for requesting payments or storing payment information:

Policy does not apply to non-covered/not medically necessary services provided only after member was informed in writing and provided signed consent to be financially responsible.

See policy NOTE about advance written notification/consent.

Providers may request payment or payment information (credit, debit, HSA/FSA) at point of service but may not require pre-claim collection of deductibles or member cost share for consumer-driven (CDH) plans; care, scheduling, or services must not be disrupted if a member declines to provide payment information or to pay prior to adjudication.

Providers should submit claims and await BCBSRI remittance advice before billing for cost share applied to deductible/CDH plans.

If a member elects to pay before claim adjudication, the provider must inform the member that the amount is an estimate and that final member cost-share responsibility may differ after BCBSRI adjudication.

Estimate disclosure required when member pays voluntarily prior to adjudication.

When BCBSRI remittance advice indicates the member overpaid, the provider must automatically refund any overpayment in a timely manner to the original payment source without requiring the member to request the refund.

Refunds must be issued automatically to the original payment method.

Members may direct that no charges be applied to stored financial information until the provider's claim is fully adjudicated and remittance advice is received; any charges applied without the member's written consent make the provider responsible for bank/credit card penalties (e.g., overdraft/overlimit).

Providers are liable for penalties if charging without written consent.

Providers may follow standard collection procedures for outstanding balances that comply with BCBSRI standards and may decline to schedule routine/non-urgent future appointments until outstanding balances are paid, consistent with this policy.

Collections and withholding routine/non-urgent scheduling permitted when consistent with BCBSRI standards.

Providers must not deny or discriminate in furnishing health care services based on protected characteristics or source of payment, consistent with provider contract obligations.

Non-discrimination requirement reiterated in policy background.

Medical criteria, prior authorization, coverage, and coding sections are not applicable to this administrative policy.

Policy pertains to administrative/payment practices only.

Provider Billing and Operational Requirements

Billing Rule

Point-of-service payment and retained payment information rules

BCBSRI does not allow a patient’s care, scheduling of care, or services to be compromised or disrupted if a member chooses not to provide requested financial information prior to a service. For consumer-driven plans (HSA, HRA, FSA), in-network providers may not require payment of amounts that would apply toward the member’s deductible or cost share at point of service before BCBSRI has processed the claim.

If a member elects to pay prior to adjudication, the provider must inform the member the amount is an estimate and final member responsibility may change after BCBSRI adjudication.
Providers must submit claims to BCBSRI before expecting final member cost-share amounts; bill the member only after receiving BCBSRI remittance advice indicating the amount applied to the member’s cost share/out-of-pocket expense.

Documentation Required

Collections and scheduling

If a member chooses to provide financial payment information prior to a service, the provider must inform the member of their option to require that no charges be applied to the payment method on file until the provider submits a claim and receives BCBSRI remittance advice showing final adjudication. If the provider receives BCBSRI remittance advice that indicates the member overpaid, the provider must automatically issue a refund to the member in a timely manner without requiring the member to request it, and refund to the original source of payment.

Providers must notify members, before collecting payment, that the member may opt to withhold authorization to charge the payment method until claim adjudication is complete.
Refunds for overpayment must be processed promptly and without requiring member follow-up; refunds should be returned to the original payment source.

Denial Risk

Unauthorized charges and liability

If charges are applied to a member’s payment information without the member’s written consent (even if ultimately determined to be the member’s liability), the provider is responsible for any bank or credit card penalties incurred (for example, overdraft or overlimit fees). Providers may follow standard collection procedures for outstanding balances only if those procedures meet all BCBSRI standards. Providers may withhold scheduling of future routine or non‑urgent appointments for members with outstanding balances until the balance is paid in full.

Do not charge a member’s payment method without their written consent unless the member previously authorized immediate charges.
Providers are liable for any financial penalties resulting from unauthorized charges.
Standard collection practices are permitted only when compliant with BCBSRI requirements; routine/non‑urgent appointments may be postponed for unpaid balances.

Definitions: Point-of-Service Payment and Stored Financial Information

Point-of-service payment/financial information on file

DefinitionProviders requesting payment at point of service or retaining member credit/debit/HSA/FSA card information to charge for services or outstanding balances; use limited to member-directed purposes and subject to consent rules.

ApplicabilityDoes not apply to services determined to be not medically necessary or non-covered when the member was notified in writing and provided signed advance consent to be financially responsible.

Permitted useFinancial information may be kept on file and used only per member direction and the policy's permitted practices (e.g., charging with consent after adjudication or as member-authorized).

Non-discriminationProviders must not deny, limit, condition, or discriminate in furnishing health care or in quality of services based on protected characteristics or source of payment, per provider contracts.

Member rightsMembers may direct that no charges be applied to stored payment information until claims are fully adjudicated and remittance is received; charges without written consent may make the provider liable for penalties.