Providers are notified in writing of all overpayments identified by the health and dental claims administrator or pharmacy benefit manager. Overpayments are recovered either by a refund check from the provider and/or benefit reductions of subsequent claims. The provider has 60 days to reply to the initial overpayment letter. If no attempt is made to respond to the claims administrator, subsequent benefit payments are reduced until the overpayment is satisfied.
Underpaid claims are adjusted and additional benefits are issued to the appropriate payee.