Overpayment Notification 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. WPS will not accept overpayment set ups over the telephone. The form must be used and mailed to the appropriate address below.

Financial Addresses for Mailing Overpayment Notification Form

IA KS MO NE
WPS Medicare Part B
Financial Unit
P.O. Box 8550
Madison, WI 53708-8550 		WPS Medicare Part B
Financial Unit
P.O. Box 7238
Madison, WI 53707-7238 		WPS Medicare Part B
Financial Unit
P.O. Box 14260
Madison, WI 53708-0260 		WPS Medicare Part B
Financial Unit
P.O. Box 8667
Madison, WI 53708-8667

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.
  3. Ensure your request is on the appropriate form, the MSP Overpayment Notification form or the Non-MSP Overpayment Notification form.
  4. Fill out each field of the form as complete and accurate as possible. Complete and accurate information is needed to process your request efficiently.
  5. Ensure your request is on the most current form version available on our website.
  6. Immediate recoupment (offset) may not be requested with the overpayment form.
  7. Providers have the option after receiving their demand letter to request an immediate recoupment. The request can be for a specific demand letter or as a permanent request for all future overpayments. They may do this by filling out the Immediate Recoupment Request form. The forms and instructions can be found on the Forms page of our website. The Immediate Recoupment form is needed to complete the request.
  8. Requesting an immediate recoupment does not eliminate interest payments when the AR is not offset in full within 30 days.
  9. Once the Overpayment Notification form is processed, the claim adjustment will appear on your remit with a PLB reason code, FB indicator. This is not a recoupment (offset), which will show up on a remit with a WO indicator.
  10. Detailed information about the overpayment on your remit, i.e. date of service and beneficiary name can be found on C-SNAPExternal Link, or by comparing the remit FCN to the invoice number on the demand letter. If unable to locate the needed information, call our Customer Service Department. Contact information for Customer Service is available on the Contact Us page of our website.
  11. Do not use this form for sending in Voluntary refunds.
  12. Please do not fax the Overpayment Notification Form. Mail to the address above.

The Overpayment Notification forms are located under the heading Financial on the Forms web page.

Page Last Updated: Friday, 09-Mar-2012 15:17:58 CST