Provider Alert! Reminder of mailing address and procedure for overpayments

Attention: All Providers
Effective Date: March 20, 2020

Should a provider receive an overpayment from Texas Children’s Health Plan they should immediately take the following action. A provider has an obligation to notify Texas Children’s

Health Plan in writing upon identification of an overpayment, no more than thirty (30) days from the date of discovery. The overpayment can be remediated through refund to Texas Children’s Health Plan, or a provider may request a recoupment from future claim payments.

For refunds:
If a provider wishes to refund the overpayment by issuing a check to Texas Children’s Health Plan, the refund check must be submitted within thirty (30) days of notification of the overpayment, or sixty (60) days from the date of the discovery of the overpayment, whichever is less. If a refund check is not received within that timeframe, Texas Children’s Health Plan will proceed with recoupment of the overpayment(s). Do not mail letters, correspondence, or other documentation that does not contain a check payment to the address below. This address is only for check payments. To submit a refund check, a provider should mail the check and the supporting documentation to:

Texas Children’s Health Plan

P.O. Box 841976

Dallas, TX 75284-1976

Supporting documentation:

• Provider name
• Tax identification number and NPI
• Refund amount for each claim and claim number
• Member name and ID number
• In the case of incorrect coordination of benefits, the primary carrier’s explanation of benefits statement.
• Reason for refund or recoupment
• Any other documentation, which would assist in accurate crediting of the refund.

For recoupments:
If a provider requests Texas Children’s Health Plan recoups the overpayment, the prior erroneous payment(s) will be reversed within thirty (30) to sixty (60) days of receipt of the request. When the

overpayment is recouped, the reversal of the prior payment will be reflected on the provider’s Explanation of Payment (EOP) after the claim is adjusted and the monies that were paid prior will be deducted from the net amount due for claim payments as documented on the current EOP. To submit a request to recoup an overpayment, a provider should mail the written request and supporting documentation to:

Texas Children’s Health Plan

Attention: Claims Administration Refund Department

P.O. Box 300286

Houston, TX 77230-0286

Next steps for providers: Providers should follow the outlined procedure and timeline for notification.

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.