Reimbursement Overpayment Process

While Payors contracted or affiliated with HealthLink make reasonable efforts to pay claims properly upon receipt, occasionally overpayments may occur. If a health care provider becomes aware of an overpayment or mistake in payment (either through the provider's discovery, from the health plan's claims administrator or health carrier, or through a written notification from HealthLink), the provider is required to refund the amount due to the health plan.

Refund per Written Request from a Claims Administrator or Health Carrier Accessing the HealthLink Network:

A claims administrator (other than HealthLink) or health carrier may send a letter of explanation and request for return of amounts due to an overpayment. In this event, please send the check or money order along with the patient's name, enrollee identification number, and/or claim number to the claims administrator or health carrier who has requested the information. Do not remit payment to HealthLink because HealthLink is not the claims administrator and does not administer the health plan's benefits or claim payments.

Refund per Written Request from HealthLink:

In the event that HealthLink is the claims administrator and an overpayment has been made to a participating HealthLink physician, hospital or health care professional, HealthLink will deduct the amount from future remittances until the overpayment is reconciled for the health plan.

When this situation arises, it is typically the result of interim billing processes for extended inpatient care. The specific claim and claim information appears on the adjustment code remark on the provider's HealthLink remittance advice.

Discovery of overpayments or questions regarding an offset or recoupment balance may be addressed by calling HealthLink Customer Service at 800-624-2356.

Reimbursement/Underpayment and Verification Process
General Inquiries:

For general inquiries about claims payment and benefit determinations, physicians, hospitals and other health care professionals should contact the plan administrator identified on the remittance advice or explanation of benefits accompanying the payment. The plan administrator can answer questions about applicable coinsurance and deductible amounts, or other service charges that may be the individual's responsibility. The plan administrator's name and telephone number typically appears on the remittance advice. Also, HealthLink can provide health care providers with the name and telephone number of the plan administrator.

For questions about the HealthLink contract amount, participating providers should contact HealthLink. There are three resources to assist in confirming the HealthLink contract amount:

  1. HealthLink Network Service Consultant who works with the practice or facility;
  2. HealthLink Customer Call Center Representatives: 1-800-624-2356; or,
  3. If the question is specific to a particular claim, access HealthLink ProviderInfoSource:

If HealthLink determines that a pricing error has occurred in relationship to an underpayment, HealthLink's Customer Service or Network Service staff will forward the claim(s) for adjustment and send the adjustment to the applicable payor with notice of the corrected HealthLink allowed amount. If the service or procedure was priced according to the contract amount, HealthLink's Customer Service or Network Service staff member will confirm this fact and assist the participating provider, as appropriate, with confirming the contract rate with the applicable payor, as appropriate.