Recoupment of Overpayments
Health Net Federal Services, LLC (HNFS) will notify providers via U.S. mail of overpayments made to them and request any overpayments be returned by check or money order.
Mail the check/money order in the self-addressed envelope to:
Health Net Federal Services, LLC
PO Box 2890
Rancho Cordova, CA 95741-9997
If the return of the overpayment is not received within 15 days from the date of the letter, HNFS will offset the amount of the overpayment against future PCCC and VCP claims.
Note: If you received an overpayment for a claim but did not receive a recoupment letter yet, you do not need to wait for a recoupment letter from HNFS. You can return the overpayment to HNFS to the address listed above. Be sure to include a copy of the original payment remittance advice, or include the veteran's name, date of birth, date of service, provider name, provider tax ID, claim ID, original check amount and the overpayment amount.
Recoupment reconsideration requests
If you believe HNFS' recoupment effort is incorrect, you may request a review from HNFS. The request must be:
- in writing,
- identify all disputed claims by claim number,
- specify the reason(s) why you believe the recoupment is in error, and
- include all supporting documentation and a copy of HNFS' recoupment letter.
HNFS must receive the request and all required documentation no later than 90 calendar days from the date of the recoupment letter. HNFS is unable to review requests received that do not include the information listed above.
Mail recoupment reconsideration requests to:
Health Net Federal Services, LLC
PO Box 2606
Virginia Beach, VA 23450
Note: Recoupments cannot be reversed for the following reasons (list not all inclusive):
- incorrect provider paid
- services rendered outside the authorization period
- coordination of benefits was not applied
- billing for more than is authorized for procedure(s) performed
If you require any additional information in order to address the recoupment effort, please contact Provider Services at 1-844-728-1914.
Frequently Asked Questions
Q: What are some of the common reasons for recoupments?
A: The most common reasons for recoupments are claims that are duplicates, paid to the wrong provider, have incorrect reimbursement rates, or have services that were not authorized.
Q: Can a provider receive more than one recoupment notification?
A: Yes. Given the timeline, duration and requirements of the reconciliation activities, recoupment activity will be occurring throughout HNFS’ contract close out period. HNFS is making every effort to consolidate the recoupment activities to minimize the required outreach to providers.
Q: Are providers with high volumes of recoupments receiving individualized assistance?
A: Yes. Once HNFS has determined the providers with a high volume of recoupments, they will receive a telephone call from HNFS in addition to recoupment letters. During that call, HNFS will offer a point of contact for providers who need help reviewing/sorting through the payments.
Q: May I bill the veteran to recoup any costs?
A: Per the network provider agreement with HNFS (for PCCC) and/or the VCP Participation Agreement signed prior to rendering services, providers agree to not bill veterans for services authorized by HNFS, outside of applicable copayments, coinsurance or deductibles of the veteran’s other health insurance.