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Overpayment of Claims

If Serra Community Medical Clinic, Inc determines that an overpayment has occurred, Serra Community Medical Clinic, Inc will notify the provider of service in writing within 365 days of the date of payment on the overpaid claim through a separate notice that includes the following information:

 

  • Member name
  • Claim ID number
  • Date of service
  • Clear explanation of why Serra Community Medical Clinic, Inc believes the claim was overpaid
  • The amount of overpayment, including interest and penalties

 

The provider of service has 30 business days to submit a written dispute to Serra Community Medical Clinic, Inc if the provider does not believe an overpayment has occurred. In this case, Serra Community Medical Clinic, Inc will treat the claims overpayment issue as a provider dispute.

 

If the provider does not dispute the overpayment, the provider of service must reimburse Serra Community Medical Clinic, Inc within 30 business days from the receipt of Serra Community Medical Clinic, Inc’s notice or, as permitted by law, interest shall begin to accrue at the rate of 10 percent per year beginning with the first day after the 30 business-day period.

 

Serra Community Medical Clinic, Inc may recoup uncontested overpayments by offsetting overpayments from payments for a provider’s current claims for services if:

 

  • The overpayment is not reimbursed within 30 business days of the notice of overpayment
  • The provider’s Provider Services Agreement (PSA) with Serra Community Medical Clinic, Inc authorizes it to offset overpayments from payments for current claims for services

 

A written notification will be sent to the provider of service if an overpayment is recouped through offsets to claim payments. The notification will identify the specific overpayment and the claim ID number