Refunds
If you receive payment for a recipient who is not your patient or are paid more than once for the same service, it is your responsibility to refund the Alabama Medicaid Program.
Provide refunds to the Medicaid Program by using the Check Refund Form (a sample can be found in Appendix E) accompanied by a check for the refund amount. Make the check payable to:
HP – Refunds
P.O. Box 241684
Montgomery, AL 36124-1684
Please provide the following information in the appropriate fields on the Check Refund Request exactly as it appears on your Remittance Advice (RA) for each refund you send to HP:
• Provider Name and NPI
• Your check number, check date, check amount
• 13 digit claim number or ICN (from RA)
• Recipient’s Medicaid ID number and name (from RA)
• Dates of service
• Date of Medicaid payment
• Date of service being refunded
• Services being refunded
• Amount of refund
• Amount of insurance received, if applicable (third party source other than
Medicare)
• Insurance name, address and policy number
• Reason for return (from codes listed on form)
• Signature, date and telephone number
This information will allow your refunds to be processed accurately and efficiently.
