**Major Group no longer utilizes this procedure**

Policy Statement:
If, as the result of an inquiry from a member, the Corporation conducts a post-payment review and subsequently determines that the initial payment was more than the Corporation’s liability on an individual claim, a refund is not requested for the overpayment unless the overpayment amount exceeds $250.00

A refund request for an overpayment in excess of $250.00 discovered due to a member inquiry must be approved by the Senior Vice-President of the operation’s division prior to beginning recoupment activities.  The refund can be requested no later than the end of the calendar year following the year in which payment was made.

This policy applies only to overpayments detected due to a member inquiry and is not to be used for overpayments discovered as a result of provider inquiries or other investigative efforts (e.g., processor review, or audits).

NOTE:  ASO groups may follow different guidelines than those described above.  When appropriate, departmental procedures established by the group administrator should be used.

NOTE:  Group and Individual - See departmental desk procedures

NOTE:  Major Group is excluded from this policy.