Author Topic: Adjustments to previously processed claims  (Read 1521 times)

CALI

  • Newbie
  • *
  • Posts: 24
Adjustments to previously processed claims
« on: April 25, 2013, 01:26:06 PM »
Hi,
I just rec'd  an adjusted EOB for claims originally processed in 2011 stating claims were incorrectly paid  & therefore the insurance company is wanting reimbursement; are there any  paramaters insurance companies must follow to request refunds similar to providers having timely filing rules? Do providers have any recourse?
Thanks,
Doris

PMRNC

  • Hero Member
  • *****
  • Posts: 4252
    • One Stop Resources & Networking for Medical Billers
Re: Adjustments to previously processed claims
« Reply #1 on: April 25, 2013, 05:58:26 PM »
It's a state by state law. You want to research Recoup / Recovery time limits for your state. Some have no limit, some are 6 months, some are 2 years. Not likely the carrier violated that time limit, all the carriers have pretty tough edits on their system to account for state/federal laws.

I should also note that it depends on the claim and what's being recouped, if there was an error in eligibility the carrier has a right to recoup any/all payments because they have a right to carry out an investigation. If there are claims paid in error involving dollar amount, most likely the carrier has the edits by state law loaded so not likely they are in the wrong, if you don't send them the money they may have the right to deduct from future claims.

« Last Edit: April 25, 2013, 06:01:19 PM by PMRNC »
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

CALI

  • Newbie
  • *
  • Posts: 24
Re: Adjustments to previously processed claims
« Reply #2 on: April 26, 2013, 11:04:38 AM »
Thanks for your response
Doris