The adjustment process outlined below applies to physicians, other health care professionals and facilities. Please reference your Asuris participating agreement to verify the adjustment process.
Payments are occasionally recouped due to a duplicate or adjusted claim. Asuris does not initiate overpayment recovery efforts more than 24 months after the claim is paid. If a provider suspects a claim has been overpaid, Washington State law allows 24 months to initiate a refund after the claim is paid or denied. 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. The remittance voucher may serve as written notification although in most situations a letter will be sent unless you have opted out of the notice process.
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
Other party liability (OPL) adjustments
We 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
Once you have been notified of the recoupment, your office will have 45 days to respond. To expedite the refund process, please respond immediately. If we do not receive a response after 45 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.
Note: If your overpayment requires documentation to adjust the claim, such as an Explanation of Benefits (EOB) or other party liability documentation, etc., please use the Overpayment/Voucher Deduction form (PDF) and include a copy of the appropriate documentation.
Deduction requests with attachments:
To request a deduction to a future voucher please complete our Overpayment/Voucher Deduction (PDF) form. Overpayments for Medicare Advantage claims may also be submitted using this form. This form can be downloaded and emailed or faxed.
Deduction requests with no attachments:
To request a deduction to a future voucher for all lines of business please complete our Overpayment/Voucher Deduction Request form. If you need a copy of the completed form, please print the page before selecting Submit. We will contact you should additional information be required.
Send a refund check to Asuris:
Complete a Refund Notification (PDF) form.
Always attach a copy of the payment voucher, overpayment recovery request or other payer's EOB and send separate checks for Asuris TruAdvantage.
If you have a question regarding the original claim related to the recoupment request, please review the remittance advice or check the claim status.
If a provider wishes to appeal a refund request initiated by Asuris, he or she may submit an Adverse Determination Appeal within the same timeframe as other Adverse Determination Appeals as listed in the Appeals section of our Administrative Manual. Note: The timeframe begins when the provider receives the written request.