Overpayment Notifications Form Instructions

WPS Medicare offers providers the opportunity to identify and request an overpayment set up by completing an Overpayment Notification Form and mailing it to one of the below addresses.

Financial Addresses

What providers need to know about Overpayment Notifications:

1. Requests for overpayment set-ups will be processed within 45 days after the date they are received in our mailroom.
2. After an overpayment has been created, the provider will have 30 days to refund the money requested without accruing interest (60 days if the overpayment is due to MSP.)
3. If no response or payment is received within 30 days of the initial demand letter, a second request letter will be automatically issued to the provider.
4. Providers have the option after receiving their demand letter to request an immediate offset. They may do this by filling out the Immediate Offset Request form. (See instructions for this under Immediate Offset). If a provider does not want an immediate offset done, they may issue a check for the overpayment. Providers can also request immediate offset when the overpayment is identified by checking the appropriate box on the Notification form.
5. Requesting an immediate offset does not eliminate interest payments when the AR is not offset in full within 30 days.
6. Once the Overpayment Notification form is processed, the claim adjustment will appear on your remit with an FB indicator. This is not an offset. An offset will show up on a remit with a WO indicator.
7. Do not use this form for sending in Voluntary refunds
8. Do not use this form to request immediate offset of an existing overpayment

Select this link for the Overpayment Notification Form.

Page Last Updated: Wednesday, 16-Dec-2009 13:38:17 CST