Last Modified: 5/25/2018 Location: FL, PR, USVI Business: Part B
What form do providers use to notify Medicare of an MSP overpayment?
Q. What form do providers use to notify Medicare of an MSP overpayment?
A. When a provider determines that a Medicare overpayment exists, the following steps must occur.
• Complete the Medicare Secondary Payer overpayment refund form
Florida providers click here for form
Puerto Rico providers click here for form
U.S. Virgin Islands providers click here for form
• Provide a refund check
• List all Medicare claim numbers included in the overpayment or a copy of the Medicare remittance notices with detailed claim information (Name, Medicare ID #, date of service, procedure code and billed amount)
• Include the other insurer’s Explanation of Benefits (EOB) every claim involved. The other insurer’s EOB must have the insurer’s name and address.
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