For providers who receive State or Federal funds, there is no time limitation for requesting reimbursement of overpayments. Health Partners Plans (Medicaid and CHIP programs), however, follow the same recovery time period guidelines for certain claims as adopted by the Pennsylvania Department of Human Services (DHS): Two years from the date of payment notice.

If an overpayment is found, recovery will be initiated and reflected on the provider’s then-current Explanation of Payment. If the amount owed by a provider exceeds the amount of money to be paid within a payment cycle(s), an Explanation of Payment(s) will generate a $0 payment. The provider is responsible for tracking their own balance until the credit balance is cleared.