Category Archives: Health Plans

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 »

Indian Health Service Recovery Efforts Against Commercial Health Plans

Health plans across the country are increasingly receiving demands for payment from the Indian Health Service, tribal health programs (“Indian Organizations”) and the U.S. Department of the Treasury for services provided by Indian Organizations to a health plan’s members. These claims for recovery are premised on the fact that Indian Organizations are generally considered a … Continue Reading »