Reminder – Provider Overpayments
| Date: | November 18, 2022 |
| To: | HPSJ Contracted Providers and Facilities |
| From: | Health Plan of San Joaquin (HPSJ) |
| Subject: | Reminder – Provider Overpayments |
| Business: | Medi-Cal Managed Care |
In accordance with the California Department of Health Care Services (DHCS) All Plan Letters (APLs), 17-003 Treatment of Recoveries Made by the Managed Care Health Plan of Overpayments to Providers, 21-002 Cost Avoidance and Post-Payment Recovery for Other Health Coverage and the California Knox-Keene Act:
If a provider identifies an overpayment for services rendered along with supplemental payments through any of the Prop 56 programs, the provider is required to inform HPSJ and return the overpayment to HPSJ within thirty (30) working days from the date the provider identifies the overpayment.
Provider Identified Overpayment:
When reimbursing an overpayment, include the following information:
- The HPSJ Claim Number(s) associated with the overpayment
- If it is a specific line or service on the claim, identify the specific service line and dollar amount of the overpayment.
- A specific reason for the overpayment
HPSJ Identified Overpayment:
If HPSJ determines that it has overpaid a claim, either in connection with an audit or otherwise, HPSJ will notify the Provider in writing through a separate overpayment notice clearly identifying the claim number(s), member(s), date of service, explanation of overpayment and interest and penalties that may be due (see section 10-5 of provider manual).
Overpayment notices will be sent to the Provider’s address of record with HPSJ for the receipt of claim-related correspondence and payments unless the Provider informs HPSJ in writing at least thirty (30) days in advance of the address change of an alternative address to which such notices are to be sent.
Non-Contested Overpayment:
If the Provider does not contest HPSJ’s overpayment notice, the Provider must reimburse HPSJ within thirty (30) business days from the date of receipt of the overpayment notice.
Be advised, pursuant to section 1371.1 of the Health and Safety Code if a provider does not make reimbursement for an uncontested overpayment within thirty (30) business days after date of notification HPSJ will be reporting noncompliant providers to DHCS.
Please see Section 10: Claim Submission – Claim Overpayment for additional information on how to contest an overpayment notice and offsetting against future claims guidelines.
Please reference DHCS APL17-003:
https://www.dhcs.ca.gov/formsandpubs/Documents/MMCDAPLsandPolicyLetters/APL2017/APL17-003.pdf
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared.