Claims Overpayment Recovery

We strive for 100% payment accuracy but recognize that a small percentage of overpayments may occur during claims processing. An overpayment can occur due to plan member disenrollment, inappropriate coding, a corrected claims submission, duplication of payments, unauthorized services, erroneous contract or fee-schedule reimbursement, noncovered benefits, and other reasons. We proactively identify and attempt to correct inappropriate provider payments and make every effort to send providers written notice explaining an overpayment reason, the amount, contact information, and directions and options for sending a refund. Note: If you submit a corrected claim for an overpayment, an automatic payment adjustment will be made to the original claim submitted, and we will not send an overpayment notice.