Nov. 26, 2024
We have recently identified some Medicare Advantage claims that have been paid incorrectly to hospitals and ancillary providers. These are claims that have been overpaid based on your contract, Centers for Medicare & Medicare Services guidelines or retroactive member updates.
What’s next: We will begin a recoupment process to collect funds from the impacted claims billed with dates of service in the past 18 months. You will receive a letter if you have any claims that have been identified as being overpaid and will have 45 days to dispute before we move forward with a recoupment. Your explanation of benefits will list any claims that are recouped as part of this project.
Additional Information: As a reminder, you may not balance bill members for any funds owed in these recoupments.
Please contact Provider Customer Service at 877-774-8592 if you have any questions or need assistance.