Admin Simp Tools: Adjustments to Payments

	Administrative Simplification Tools

Administrative Simplification Tools : Adjustments to Payments

Adjustments to Payments

How Health Plans Handle Under Payments and Over Payments

You can CUSTOMIZE YOUR OWN REPORT of How Health Plans Handle Under Payments and Over Payments. First select the questions you'd like to see, and then select up to 4 health plans. If you want more than 4 health plans, run this report again.

Step 1: Select your questions of interest

	Select All
	How will under payments be handled? How does the health plan provide additional payments on previously adjudicated claims (paid) claims?
	If the health plan identifies the overpayment, can providers choose to adjust the paid amount by requesting either a 'take back' or a 'refund'?
	Does the health plan have a form for requesting a 'take back' or submitting a 'refund'?
	What if the Provider identifies the overpayment? Is there a different procedure?
	Does the health plan send notice or a letter requesting a 'refund'?
	What steps should be followed if a Provider wants to send a refund check to one of the health plans?
	How will the health plan handle the voiding and reissue of a check that was never received by a provider? What is the timing of the re-issue once the plan is notified?
	How will internal adjustments, e.g. transfers of history from one ID to another, be reflected?

Step 2: Select health plans (limit four)

	First Choice Health Administrators		Group Health		Premera Blue Cross		Regence BlueShield
	Aetna		Asuris		HRSA (Health & Recovery Services Administration)		PacifiCare, a UnitedHealthcare Company
	UMP		Molina Healthcare of Washington
Information not yet available from the following:
na	Cigna Healthcare	na	Columbia United Providers	na	Community Health Plan of Washington	na	Kaiser Permanente Northwest
na	KPS Healthcare	na	L&I	na	One Health Plan of Washington

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» Inpatient Stay Review
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