Department of Health Care Finance - DHCF

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Surveillance/Utilization Branch Overpayment Notice

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This notice provides information for both informal and formal dispute resolution processes. These processes must be requested no later than anywhere from 30 to 60 days (depending on the category of service being delivered and the specific regulations that govern that service) after the provider receives the overpayment notice. The informal process allows the provider to submit documentation to dispute the overpayment finding. If the Division of Program Integrity agrees with the documentation, the overpayment may be revised. Providers may access both the informal and formal dispute resolution processes simultaneously, or choose one or the other. Accessing the informal process does not extend the 15-day timeframe for requesting a formal dispute resolution hearing.