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Commercial - Administrative Procedures |
Refunds/Overpayments
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ConnectiCare reserves the right to utilize third-party vendors to
identify claim overpayments made to providers. View complete listing of approved
vendors online, or call Provider Services at
1-800-828-3407.
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In the event that you receive an overpayment of claims, duplicate payment, or
payment for claims that were reimbursed inaccurately, we request you refund the
appropriate amount to ConnectiCare. We will identify and request reimbursement
of overpayments within 18 months of the date the claim was paid. No requests for
refunds beyond this time limit will be requested, unless the overpayment is due
to fraudulent billing activity. If you would like ConnectiCare to take back
the overpayment through future claims payment, or when you identify an
overpayment prior to a notification from ConnectiCare:
• complete a Standard Provider Refund Form
• send to: ConnectiCare, Inc., P.O. Box 416608, Boston, MA 02241-6608
• send a copy of the Explanation of Payment
• provide an explanation of why you are sending the refund (e.g., duplicate
payment; billed claim in error)
In the event that we notify you in writing that ConnectiCare has identified a
payment error in an amount exceeding the amount due to you, you will be
responsible for making the applicable refund.
• Refunds must be received within thirty (30) days of receipt of notice, unless
alternative arrangements are made in writing and accepted by ConnectiCare.
• If payment is not received within the 30-day time frame, ConnectiCare will
notify you that the overpayment amount will be taken back through future claims
payment.
• If you dispute the overpayment amount, you must notify ConnectiCare in writing
within fifteen (15) days of the initial overpayment notice.
In the event that you fail to respond to the notice for refund, ConnectiCare
retains the right to terminate your participation with ConnectiCare and/or to
offset the amount due ConnectiCare against any monies due to you, including but
not limited to any withhold return due to you.
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