Tuesday, July 28, 2015

Overpayments: Identifying Specific Patients

Each overpayment letter mailed by Palmetto GBA contains one or more Invoice Numbers as well as a list of the specific patients and dates of service included in the overpaid amount(s). The same Invoice Number will appear as an FCN on your remittance notice if the overpaid amounts are withheld (offset) from a payment. The Invoice Number is equivalent to an 'accounts receivable' number.

The Invoice Number is the best way to identify the specific patients associated with overpayments. Please retain the letter containing the invoice number(s) associated with each overpayment notification. There may be multiple overpayments included in a single letter. It may be helpful to make a list of patients associated with any overpayment letters you receive from Palmetto GBA and use this information to match up to the Invoice number(s) on subsequent remittance notices.

Electronic Remittance Advice Notices (ERAs):

The Invoice Number appears in the PLB segment

Some commercial software does not map the data on the PLB segment from Palmetto GBA’s ERA file to the ERA file you actually view. If you are not able to view Invoice Numbers associated with ERAs, we suggest that you contact your software vendor directly.

Once you retrieve your ERA file, Palmetto GBA can no longer view or provide the Invoice Numbers
Standard Provider Remittance Notices (SPRs):

If a refund is not received within 30 days, we will begin recoupment procedures from future payments for your Tax ID number. When the recoupment has been completed, Palmetto GBA will send you a remittance notice to notify you that the overpayment has been satisfied. Toward the end of your remittance notice, you will find a Withholding (WO) reason code, followed by the Invoice number(s) associated with the overpayment(s).

An overpayment is created with Invoice number 369709356457060. Palmetto GBA will send you a remittance notice to notify you that an overpayment has been created.

You will receive a 'demand letter' which will contain the total amount of the overpayment and the invoice number(s) associated with the overpayment. We strongly recommend that you retain this information for future reference.

If a refund is not received timely, we will send you another remittance notice with the WO reason code followed by invoice number 369709356457060. The letter you received from Palmetto GBA, notifying you of the overpayment, will contain the name of the patient that is associated with the overpayment

No comments:

Post a Comment

Popular Posts