What must providers do when a duplicate primary payment is received FAQ

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Home ► FAQs ► Answers ► What must providers do when a duplicate primary payment is received FAQ

Last Modified: 4/9/2025 Location: FL, PR, USVI Business: Part B

What must providers do when a duplicate primary payment is received?

Q. What must providers do when a duplicate primary payment is received?

A. When a provider receives primary payments from Medicare and another insurer for the same service billed, provider must repay the overpayment within 60 days of the receipt of the duplicate payment.

The following steps will ensure proper correction to Medicare records and calculation of secondary payment is made.

• Determine if an overpayment exists by calculating the Medicare secondary payment. The difference of what Medicare paid and the Medicare secondary payment amount is the overpayment amount. See How is a Medicare secondary payment determined?

• Complete and submit the Medicare secondary payer overpayment refund form (see below), indicating all appropriate MSP information. Attach copies of the related remittances or list all claim information for multiple on a separate sheet or CD.

• Send a refund check for the overpaid amount within 60 days of the date the duplicate payment was received

• Send the other insurer’s explanation of benefits (EOB) and/or payment information. This EOB must contain claim and detail level data, such as the date of service, procedure code or HCPCS descriptor, billed amount, paid amount, deductible applied and processing remarks. (Contact the other insurer for a breakdown if these are not on the EOB received.)

• Mail ALL of these to:

Florida providers:

Click here for form pdf file

JN Part B Florida Debt Recovery and Check Mail

P. O. Box 3092

Mechanicsburg, PA 17055-1810

Puerto Rico and U.S. Virgin Islands providers:

Click here for form pdf file

JN Part B Puerto Rico and Virgin Islands Debt Recovery and Check Mail

P. O. Box 3121

Mechanicsburg, PA 17055-1831

Source: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads//fin106c03.pdf external pdf file

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