Claim Payment and Overpayment Changes
HealthTeam Advantage makes every attempt to identify claim overpayments and issue provider notices for an overpayment refund request within 30 days, but in no case more than 12 months after the date of the original payment.
Should an overpayment occur, HealthTeam Advantage will send a claim overpayment refund request letter with detailed claim information about the payment error and request a return of the overpayment to be returned to the plan within 30 days. If payment is not received within 30 days, a second refund request letter will be issued. The maximum written request for refunds will not exceed three (3) within ninety (90) days.
New for 2023: HealthTeam Advantage reserves the right to pursue additional overpayment recovery efforts if monies are not received. This means if no dispute is filed against the refund request, and the monies are not returned as requested, after 100 days, we will recoup/deduct the amount owed from future payments owed to you through claim activity.
If a provider receives an overpayment refund request letter from HealthTeam Advantage, the provider should follow the instructions promptly, as outlined in the letter for returning the overpayment or disputing the request. If a provider independently identifies an overpayment from HealthTeam Advantage, the following steps should be taken:
Return a check made payable to HealthTeam Advantage to:
Attn: Claim Overpayments
PO Box 744676
Atlanta, GA 30374-4676
Include a copy of the Explanation of Payment that accompanied the overpayment to expedite HealthTeam Advantage’s adjustment of the provider’s account. If the Explanation of Payment is not available, the following information must be provided:
- HealthTeam Advantage member name and ID number;
- Date of service;
- Payment amount;
- Vendor or provider name and number;
- Provider Tax Id number; and,
- Reason for the overpayment refund.