Overpayment Notifications Explained
ClaimInformatics works directly with self-funded health plans to detect and investigate overpayments. Overpayments occur from time to time for a variety of reasons. ClaimInformatics conducts a thorough, careful review with our proprietary system that contains millions of edits which we combine with a hands-on review by our experienced industry-leading experts. The Health Information Portability and Accountability Act (HIPAA) grants health plans the right to enter into agreements with Business Associates to ensure accuracy of payment activities and ClaimInformatics operates in full compliance with HIPAA.
Note, Under Federal ERISA law, there are no time limits for recovery demands when there is a belief of fraud, intentional misconduct, or abusive billing or if overpayment request is initiated at the request of a self-funded plan.
Federal ERISA law takes precedence over any State law.
Please call us today at 860-761-9570 as listed on your letter. To save time, reference the case number provided. Our Customer Service Specialists are ready to take your call. It is important that you respond to the letter in a timely manner.
The actions of ClaimInformatics are in full compliance with HIPAA. HIPAA specifically permits the health plan, a Covered Entity, to seek payment of claims without a patient authorization under 45 CFR 164.502.(a)(1)(ii). The HIPAA definition of payment includes, but is not limited to, subrogation of health benefit claims, coordination of benefits and a review of charges for healthcare services.
ClaimInformatics is committed to protecting confidential patient information and complying with HIPAA’s rigorous standards. For more information on Covered Entities and Business Associates, please visit the Health and Human Services website at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html