The adjustment process outlined below applies to physicians, other health care professionals and facilities. Please reference your Regence participating agreement to verify the adjustment process.

Payments are occasionally recouped due to a duplicate or adjusted claim. Regence does not initiate overpayment recovery efforts more than 18 months after the claim is paid. If a provider suspects a claim has been overpaid, Washington State law allows certain provider types 24 months to initiate a refund. The law allows providers 30 months to request a recoupment due to coordination of benefits (COB), or 24 months to request a recoupment for any other reason.

Washington State law requires prior written notification when a recoupment is requested by the health plan or by the provider.

• Recoupment requests for Medicare, Medicare Supplement, Healthy Options/State Children's Health Insurance Plan (SCHIP) and Federal Employee Program (FEP) members follow our current automatic deduction process for refunds.
• The legislation does not pertain to hospitals, laboratories, durable medical equipment (DME) and/or home medical equipment (HME) providers.

Note: No time limit shall apply to the initiation of overpayment recovery efforts based on any of the following criteria:

• Required by a Self-Insured Plan
• Required by a state or federal government program
• Reasonable belief of fraud or other intentional misconduct

Notification process
Regence will notify providers on the applicable remittance advice (voucher) of an impending recoupment. The notification will include the following details:

• Dollar amount
• Applicable claim number(s)
• Reason for the recoupment

Responding to a recoupment request
Once you have been notified of the recoupment, your office will have 30 days to respond. To expedite the refund process, please respond immediately. If we do not receive a response after 30 days, the recoupment will be released and automatically deducted on a future remittance advice. You may use one of the options below to respond to the recoupment request.

To refund the overpayment to Regence:

• Complete a Refund Notification (PDF) form and mail it with your refund check to the address on the form.

To request a deduction to a future voucher:

• Complete our online Overpayment/Voucher Deduction Request form

• For Boeing members
• For all other members

• Print and fax or mail a completed Overpayment/Voucher Deduction (PDF) form to one of the addresses listed below.

If your office needs additional time to refund the amount due, use one of the following options to make payment arrangements:

• Call Customer Service at 1 (800) 322-1737
• For Boeing members choose the appropriate Boeing Plan

Mail correspondence to:

• For Boeing members: P.O. Box 91015, Seattle WA 98111-9115
• For all other members: P.O. Box 21267, Seattle WA 98111-3267

If you have a question regarding the original claim related to the recoupment request, please access Provider Center (formerly Regence Online Services for Providers to view a remittance advice or check claim status.

Other Links

• Contact information
• Sample Pend Report (PDF)

Note: To print a PDF document, you need Adobe^® Reader^®. Download it now for free.