Overpayments
If you identify a claim for which you were overpaid by us, or if we inform you in writing or electronically of an overpaid claim that you do not dispute, you must send us the overpayment within thirty (30) calendar days (or as required by law), from the date of your identification of the overpayment or our request. We may also apply the overpayment against future claim payments to the extent permitted by your agreement with us and applicable law.
All refunds of overpayments in response to overpayment refund requests received from UnitedHealthcare, or one of our contracted recovery vendors, should be sent to the name and address of the entity outlined on the refund request letter. Refunds of any credit balances existing on your records should be sent to:
UnitedHealth Group Recovery Services
P.O. Box 740804
Atlanta, GA 30374-0804
Please include appropriate documentation that outlines the overpayment, including member’s name, health care ID number, date of service and amount paid. If possible, please also include a copy of the remittance advice that corresponds with the payment from UnitedHealthcare. If the refund is due as a result of coordination of benefits with another carrier, please provide a copy of the other carrier’s EOB with the refund.
When we determine that a claim was paid incorrectly, we may make claim reconsiderations without requesting additional information from the network physician, health care professional, facility or ancillary provider. In the case of an overpayment, we will request a refund at least thirty (30) days prior to implementing a claim adjustment, or as provided by applicable law or contractual agreement. You will see the adjustment on the EOB or Provider Remittance
Advice (PRA). When additional or correct information is needed, we will ask you to provide it.
If you disagree with a claim reconsideration, our request for an overpayment refund or a recovery made to recoup the overpayment, you can appeal the determination (see Claim Appeals section of this Guide).
