Wiki Overpayment Incorrect?

kberger2124

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I'm hoping someone can direct me in the right direction. I had an insurance company recoup money for "overpayment" on 4 claims. After some digging, I found that the claims were not overpaid on and were actually correct. Is there a way to get that money back? Appeal? Hope someone can help me out!
 
As a claims handling compliance and appeal specialist, I will share some food for thought for you to consider. Keep in mind that the disputed or "recouped" claim was paid correctly on the original submission and you received the payment for that claim. What was not paid correctly were the claim(s) impacted by the offset that you did not receive an actual payment on. Those are the claims that were not processed and paid properly meeting applicable compliance requirements, and those are the claims that need to be appealed based on misleading allowed and paid amounts reported to the patient and provider, when $0 is the actual payment received. Most people address the wrong claim and get frustrated when they do not get anywhere. That is one of the many claims handling compliance laws and appeal strategies that I teach in depth in my one day claims handling compliance and appeal seminars.
 

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What was not paid correctly were the claim(s) impacted by the offset that you did not receive an actual payment on.

I don't see where you would get that; the OP said nothing about other claims or offset.

OP, in situations like yours, I read the overpayment request or recoupment documents very carefully. Sometimes the reason for the alleged overpayment is hidden in a paragraph of other things. If there truly is no overpayment, call the insurance company and ask them to explain to you on the phone why they feel it was overpaid, AND ask them to send you (by fax, you'll wait while they do it!!) of the corrected EOB. It may be that it was supposed to go to deductible instead of being paid.
 
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