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Last Modified: 7/8/2022 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:
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:
JN Part B Puerto Rico and Virgin Islands Debt Recovery and Check Mail
P. O. Box 3121
Mechanicsburg, PA 17055-1831
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.