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Wiki insurance recoupment

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lisahb7

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I cannot find a consistent answer to this: what is the window in which commercial payors can recoup an overpayment? Conflicted information: 180 days, 1 year, 5 years....what is the correct answer?
 
It is usually best practice to submit a request for funds to be retracted which can be the provider cutting a single check for payment, or having the extra funds recouped from a future payment, rather than wait for the insurance to recoup. Insurances have up to 7 years to reprocess and retract payments.
 
lisahb7 said:
I cannot find a consistent answer to this: what is the window in which commercial payors can recoup an overpayment? Conflicted information: 180 days, 1 year, 5 years....what is the correct answer?
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There isn't one timeframe that is applicable across all commercial payers everywhere.

You'll want to review your state-specific laws regarding recoupments as well as the recoupment clauses in your commercial insurance contracts. There may also be differences for fully-insured plans vs self-insured plans.

Generally, your state law should prevail. Also, remember that many state laws also have exceptions for special circumstances such as suspected fraud.
 
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