Can a carrier recoup a payment electronically without the provider receiving any other notification?
No. Under 28 TAC ยง21.2818 the carrier must give written notice of overpayment, including the specific claims and amounts for which refund is due and for each claim the reasons and basis for the refund request. The notice must also disclose the provider’s appeal rights and describe the methods by which the carrier intends to recover the refund. Q: What remedy does a carrier have when it pays, and did not dispute, a claim within the required time frames, but later determines after 180 days that an overpayment has been made?
