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Overpayments - Chapter 9, 2019 UnitedHealthcare Administrative Guide

If we inform you of an overpaid claim that you do not dispute, send us the refund check or recoupment request within 30 calendar days (or as required by law or your Agreement), from the date of notification. We may apply the overpayment against future claim payments unless your Agreement states otherwise or as required by law. If you find we overpaid for a claim, please use the Overpayment Refund/Notification Form. Mail refunds for overpayments to the name and address indicated on theOverpayment Refund/Notification form. Call 800-727-6735 with questions related to overpayments. Send refunds to:

Regular Mail:

UnitedHealthcare Insurance Company

P.O. Box101760

Atlanta, GA 30392-1760

Overnight Mail:

UnitedHealthcare Insurance Company – Overnight Delivery

Lockbox 101760

3585 Atlanta Ave

Hapeville, GA 30354

Please include documentation that shows the overpayment, including member’s name, health care ID number, date of service and amount paid. If possible, also include a copy of the provider remittance advice (PRA) that corresponds with our payment. If the refund is owed because of COB with another carrier, provide a copy of the other carrier’s EOB/remittance advice with the refund.

If we find a claim was paid incorrectly,incorrectly, we may make a claim adjustment. You will see the adjustment on the EOB or PRA.

Dispute

If you disagree with the claim adjustment, our request for an overpayment refund or recoupment, you may dispute.

Submit your dispute within 30 calendar days from the date you receive the overpayment notification letter. Your dispute must clearly state the items in dispute, with the relevant authority and supporting documentation for the disputed items. We respond to notifications of disputed audit findings in writing within 30 calendar days of receipt.

Direct Connect

Direct Connect is a no-cost web-based platform that helps payers and providers communicate effectively, automate workflows and drive resolutions. This portal has the ability to replace previous methods of letters, faxes, phone calls and spreadsheets. It also helps:

  • Track and manage overpayments in a controlled process
  • Create a transparent view between provider and payer
  • Avoid duplicate recoupment and returned checks
  • Decrease resolution timeframes
  • Real-time reporting to track statuses of inventories in resolution process
  • Provide control over financial resolution method
  • Manage and review overpayment disputes
  • Attach images for quick reference

Access Direct Connect using Link. Onsite and online training is available.

Email directconnectsupport@optum.com to get started with Direct Connect.