Author Archives: John West

Managing Overpayments: A Change in Landscape

Health plans seeking overpayment recovery from network providers may need to evaluate the member’s plan with consideration to ERISA notice and appeal rights.

Recent rulings have made what was once relatively routine for health plans more challenging. Prior to these rulings, the provider claims adjudication process contemplated ongoing adjustments for underpayment and overpayment of claims, and in many cases handled cases through a notice or joint plan–provider meetings. Provider contracts typically grant the payor setoff and recoupment rights … Continue Reading »