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Automated Overpayment Recovery Process

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10/05/2011

Effective Dates:  Between September 3 – October 8, 2011(Program will roll out by State)


Between September 3, 2011 and October 8, 2011, UnitedHealthcare is updating their overpayment recovery process and Provider Remittance Advice (PRA) for all medical providers that submit claims for Medicare Solution Plans.  This applies to all participating/contracted and non-participating/non-contracted medical providers that submit claims for Secure Horizons®, and/or Evercare®, including Private-Fee-For Service.
Updates to the program are:

  • Send Providers advance notification of overpayment recoveries.  Provider will have 30 days to respond by either sending a refund check or written inquiry.  If providers do not respond, the overpayment recovery claims will offset against future claims on or after 45 days.
  • Allow automatic offsets of overpayments against future claim payments, where allowable by contract, and where the provider does not prefer direct funds.
  • Allow current claims to process against the outstanding overpayment balance
  • Enhance the PRA which will include a new “Overpayment Reduction Detail” page that states the amount of the original adjustment(s), all offsets, and the current balance.
  • Physicians enrolled in electronic funds transfer payments will receive the HIPAA 835 instead of a hard copy.
More information on the payment recovery process can be found in the September 2011 Supplement of the Network Bulletin on www.unitedhealthcareonline.com