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When an overpayment of a claim is identified by PGBA, the finance department will send a recoupment letter requesting refund of the overpayment. The first letter is sent out when the overpayment is established. A second letter is mailed at 30 days if the refund has not been received.
After 60 days, if the refund is not received, an offset flag is set in PGBA’s refund system. This offset will cue the payment system to deduct the amount you were overpaid from the next payment processed under your provider ID. A note is included at the bottom of the next remittance and will give the following information related to the offset: provider’s patient account number, patient name, TRICARE claim number, refund number, date requested (recoupment letter date), amount originally requested, amount offset, collections to date and remaining amount outstanding. In order to keep their books, providers will need to apply the offset to the claim being recouped.
It’s important to respond promptly to recoupment requests. If you submit a refund on day 55, mailing and processing may not have occurred by the time an offset is taken at the 60-day mark. This will lead to a duplicate collection. PGBA will refund the duplicate collection, but a timely refund from you will eliminate the confusion and extra workload for both entities.
Humana Military and PGBA share a continuous improvement philosophy and have targeted many initiatives to improve payment accuracy and to serve our providers better.
For more information about overpayments and refunds, please call Humana Military at 1-800-444-5445.
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