Demand Letter Contents

40.1 – Demand Letter Contents (Rev. 12946, Issued:11-08-24; Effective: 12-10-24; Implementation:12-10-24) The Contractor will demand an overpayment resulting from a claims adjustment if the claims adjustment has had no recoupment in the past 60 days. The demand letter shall include the following information: • That an overpayment was made; • That interest will begin to accrue if the overpayment is not paid in full within 30 days; • The name and Patient Control Number (PCN) of the beneficiary involved will be included in the spreadsheet attachment; • The dates and types of services for which the overpayment was made to include sufficient information for the provider to identify the overpayment; • How the overpayment was calculated; • Why it is liable for recovery of overpayment (i.e., the reasons for finding the provider at fault); • That recoupment of the overpayment from all available payments will occur on day 16 from the date of the Demand Letter; • Rebuttal language shall be included; • A reference to the Appeals rights in the remittance advice.