Administrative Policy effective January 1, 2020

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Refund Request Notification Process

We recently automated our notification process for requesting a refund on any claim we paid or overpaid in error. When we process a retraction for claims we paid or overpaid in error, a refund request will be immediately generated if we are unable to recover the money from your account in our claim system.

This process applies to the commercial line of business. We are planning to implement this notification process for Medicare claims in the near future.

Additional Information:

  • If multiple claims are being retracted, the refund request will contain a second page with the list of claims. We recommend comparing this information with your remittance statement for additional claim information.

  • Subsequent notices will be generated 30, 60, and 90 days after the original request if we have not received the money owed to us from claim overpayment.

  • If you have subsequent paid claims, the system will apply those subsequent claim payments to the amount due to us.

  • If we retract the money and receive a refund check for the same claim(s), we will issue you a refund.

  • Provider remittance statements will continue to reflect any money owed to us from claim overpayment. 

Please share this information with anyone within your office or facility who should be aware. If you have questions, please contact Customer Care at 1-866-265-5983.

Thank you for the quality of care and service that you provide to our valued members.

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