Common use of Overpayment Recovery Clause in Contracts

Overpayment Recovery. Payor(s). For purposes of this section, "refund" means the return, either directly or through an offset to a future claim, of some or all of a payment already received by a Practitioner. (1) Except in the case of fraud, or as provided in subsections (2) and (3) of this section, Group and/or WHN may not: (a) Request a refund from Practitioner of a payment previously made to satisfy a claim unless it does so in writing to Practitioner within twenty-four months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than six months after receipt of the request. Any such request must specify why the payor(s) believe(s) Practitioner owes the refund. If Practitioner fails to contest the request in writing to the payor(s) within thirty days of its receipt, the request is deemed accepted and the refund must be paid. (2) For reasons related to coordination of benefits with another payor or entity responsible for payment of a claim, Group and/or WHN may not: (a) Request a refund from Practitioner of a payment previously made to satisfy a claim unless it does so in writing to Practitioner within thirty months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than six months after receipt of the request. Any such request must specify why the payor(s) believe(s) Practitioner owes the refund, and include the name and mailing address of the entity that has primary responsibility for payment of the claim. If Practitioner fails to contest the request in writing to the payor(s) within thirty days of its receipt, the request is deemed accepted and the refund must be paid. (3) Group and/or WHN may at any time request a refund from Practitioner of a payment previously made to satisfy a claim if: (a) A third party, including a government entity, is found responsible for satisfaction of the claim as a consequence of liability imposed by law, such as tort liability; and (b) the payor(s) is(are) unable to recover directly from the third party because the third party has either already paid or will pay Practitioner for the health services covered by the claim. (4) This section does not apply to health care services provided under Title XVIII (Medicare) of the Social Security Act, or Medicare supplemental plans regulated under Revised Code of Washington Chapter 48.66.

Overpayment Recovery. Payor(s). For purposes of this section, "refund" means the return, either directly or through an offset to a future claim, of some or all of a payment already received by a Practitioner. (1) Except in the case of fraud, or as provided in subsections (2) and (3) of this section, Group and/or WHN HWHN may not: (a) Request a refund from Practitioner of a payment previously made to satisfy a claim unless it does so in writing to Practitioner within twenty-four months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than six months after receipt of the request. Any such request must specify why the payor(s) believe(s) Practitioner owes the refund. If Practitioner fails to contest the request in writing to the payor(s) within thirty days of its receipt, the request is deemed accepted and the refund must be paid. (2) For reasons related to coordination of benefits with another payor or entity responsible for payment of a claim, Group and/or WHN HWHN may not: (a) Request a refund from Practitioner of a payment previously made to satisfy a claim unless it does so in writing to Practitioner within thirty months after the date that the payment was made; or (b) request that a contested refund be paid any sooner than six months after receipt of the request. Any such request must specify why the payor(s) believe(s) Practitioner owes the refund, and include the name and mailing address of the entity that has primary responsibility for payment of the claim. If Practitioner fails to contest the request in writing to the payor(s) within thirty days of its receipt, the request is deemed accepted and the refund must be paid. (3) Group and/or WHN HWHN may at any time request a refund from Practitioner of a payment previously made to satisfy a claim if: (a) A third party, including a government entity, is found responsible for satisfaction of the claim as a consequence of liability imposed by law, such as tort liability; and (b) the payor(s) is(are) unable to recover directly from the third party because the third party has either already paid or will pay Practitioner for the health services covered by the claim. (4) This section does not apply to health care services provided under Title XVIII (Medicare) of the Social Security Act, or Medicare supplemental plans regulated under Revised Code of Washington Chapter 48.66.