FAQ 19. The Claimant is a Health Care Facility and has the option of having the Settlement determine the Health Care Facility’s estimated Allowed Amounts (Option A) or providing its own estimated Allowed Amounts (Option B). If the Health Care Facility chooses Option A when it submits its claim can the Health Care Facility change to Option B later?
No. The Health Care Facility is bound by the Option chosen. However, a Health Care Facility that chooses Option A will be provided an opportunity to review the estimated Allowed Amounts before the distribution of the Net Settlement Fund.
FAQ 20. If a Health Care Facility would like to choose option B, but it is missing data for certain years, what should it do?
If a Health Care System or Health Care Facility is only able to submit their own estimated Allowed Amounts for certain years and not others during the period from July 24, 2008 through October 4, 2024, it should still do so, and the Settlement will use the Consumer Price Index for hospital and related services to backcast the Allowed Amounts for prior years, forecast the Allowed Amounts for later years and interpolate, assuming linear growth, the Allowed Amounts for years in between years with Allowed Amounts.
FAQ 21. Is the first/last date of service period intended to represent the first date in the period the facility provided services to any patient? The first/last date where a claim was billed to a Blue product? Is there a reason the first/last date of service would differ from the start/end date for claim?
- First Date of Service Period from 07/24/2008 to 10/04/2024
- Last Date of Service Period from 07/24/2008 to 10/04/2024
- Start Date for which the Claimant is submitting the claim on behalf of the Health Care Facility
- End Date for which the Claimant is submitting the claim on behalf of the Health Care Facility
The First Date of Service Period and Last Date of Service Period represent the first date of service from 07/24/2008 to 10/04/2024 for each Health Care Facility for which you are submitting a claim, in addition to the last date of service from 07/24/2008 to 10/04/2024 for each Health Care Facility for which you are submitting a claim. The Start and End Date for which the Claimant is submitting the claim on behalf of the Health Care Facility represent the start and end date of the time period for which the Claimant is submitting the claim on behalf of each Health Care Facility. This must also be a date from 07/24/2008 to 10/04/2024.
Dates for these two ranges may be the same. In general, the dates for the Settlement Class Period (July 24, 2008 to October 4, 2024) represent a time period during which a Provider must have been one who met the Settlement Class definition. A Provider does not need to fit the Settlement Class definition for the entirety of the Settlement Class Period. Any Provider who fits the Settlement Class definition for only a portion of the Settlement Class Period is a Class Member that may recover in the Settlement. The Claims Administrator will validate claims during its review and will follow-up if more information is needed to reconcile any submissions.
FAQ 22. Can a Provider file a claim under a TIN that is no longer active but was used by the organization between 7/24/2008 - 10/4/2024? If so, how would the payment process be handled if in fact that TIN is no longer active? What if a Health Care Facility has gone through multiple ownership changes during the 7/24/2008 - 10/4/2024 time frame? Can the current ownership submit a claim under the prior ownership TINs?
If an organization had a Tax ID that is no longer active, but was used during the Settlement Class Period, the Class Member may list the tax information for the entity that will be receiving payment in Section D: Tax Form. The Claimant itself must provide a current Tax ID for our tax reporting purposes but you can include now-inactive TINs in the rider section of your claim if you own the right to file a claim for those TINs.
We cannot tell you whether or not you own the right to file a claim for a Health Care Facility that changed hands during the Class Period for the entirety of the Class Period, as the answer will depend on the terms of the transaction.
If you are unsure whether you have the right to submit a claim for a given Health Care Facility or what the extent of that right is, you can submit a claim and any conflicting claims will be resolved in the claims adjudication process.
FAQ 23. For the file upload for Option B – what are the required fields for the file? Is there a header of required information, or a preferred format to make submission easier? Where is the listing of required fields located?
You may find this information in the Rider section of the Facilities Claim Form on the Settlement website. If you are a Health Care System, you must provide the required information for all Health Care Facilities for which you are filing a claim. If you are a Health Care Facility, you must provide the required information for your facility.
Additionally, if you are a Health Care System that would prefer to provide the information for each facility one at a time, please use the Add New Rider button and complete and save the information for each facility. Alternatively, if you wish to provide the required information for multiple Health Care Facilities in bulk, instead of entering the information on the screen one facility at a time, click the Bulk Submission button and follow the instructions.
Option B (the “Alternative Method”) permits a Health Care System or Health Care Facility to submit its own estimated Allowed Amounts, which will be validated by the Settlement. Due to a lack of necessary data, estimated Allowed Amounts must be provided for Health Care Facilities not open prior to January 1, 2015 and for Health Care Facilities located in Arizona, Iowa, Louisiana, Maryland, New Jersey, South Dakota, CareFirst’s service area in Virginia, the District of Columbia and Puerto Rico. If the Settlement is unable to validate the Allowed Amounts you have claimed, you may later be required to submit documentation to support your claimed Allowed Amounts.