Overpayment Recovery

The adjustment process outlined below applies to physicians, other health care professionals and facilities. Please reference your Regence participating agreement to verify the adjustment process.

Payments are occasionally recouped due to a duplicate or adjusted claim. Utah State law, House Bill 165, enacts the following time limits for Utah insurers recovering suspected overpayments as well as providers recovering suspected underpayments.

Effective May 12, 2009:

• Maximum 36 months, if the improper payment was due to a recovery by Medicare, Medicaid, Children's Health Insurance Pool (CHIP) or any other federal health care program
• Maximum 12 months, if the improper payment was due to any other reason (other than Coordination of Benefits [COB] as noted below)

Effective July 1, 2009:

• Maximum 24 months, if the improper payment was due to COB

In the case of fraud or other intentional misconduct, the period for requesting an adjustment or disputing a claim is the maximum time allowed by law.

Notification process
Regence will notify providers on the applicable remittance advice (voucher) of an impending recoupment. The notification will include the following details:

• Dollar amount
• Applicable claim number(s)
• Reason for the recoupment

Responding to a recoupment request
Once you have been notified of the recoupment, your office will have 30 days to respond. To expedite the refund process, please respond immediately. If we do not receive a response after 30 days, the recoupment will be released and automatically deducted on a future remittance advice. You may use one of the options below to respond to the recoupment request:

To refund the overpayment to Regence:

• Complete a Refund Notification (PDF) form and mail it with your refund check to the address below:

Regence BlueCross BlueShield of Utah
PO Box 3016
Tacoma, WA 98401-3016

Always attach a copy of the payment voucher, overpayment recovery request or other carriers’s Explanation of Benefits (EOB) and send separate checks for:

• Regence (includes BlueCard^®)
• Regence MedAdvantage
• Federal Employee Program (FEP)

To request a deduction to a future voucher:

• Complete our online Overpayment/Voucher Deduction Request form
• Print and fax or mail a completed Overpayment/Voucher Deduction (PDF) form to one of the addresses listed below

If you have a question regarding the original claim related to the recoupment request, please access Provider Center to view a remittance advice or check claim status.

Appealing a recoupment request
If a provider wishes to appeal a refund request initiated by Regence, they may submit an Adverse Determination Appeal within the same timeframe as other Adverse Determination Appeals as listed in the Appeals section of our Administrative Manual. Note: The timeframe begins when the provider receives the written request.

Other Links

• Contact information
• Sample Pend Report (PDF)

Note: To print a PDF document, you need Adobe^® Reader^®. Download it now for free.