If an overpayment occurs, the medical and dental claims administrator will notify providers in writing of the amount along with the related claim information. If the amount is in excess of $10,000, providers will be contacted by phone as well. If the overpayment is not satisfied within 150 days of the initial request, the medical and dental claims administrator will recover funds from another claim or claims from the same tax ID. If the overpayment cannot be satisfied within an additional 30 days, the medical and dental claims administrator can use its own resources or those of a third party to recover overpayments.
Providers can proactively refund overpayments, otherwise HealthChoice will begin recouping all overpayments at the tax ID level.
As an exception, EGID will immediately deduct overpayments due to resubmission of a corrected claim, or if information is received for a claim pending additional information that subsequently impacts a paid claim or a mutually agreed upon audit adjustment.