Medicare Financial Management Manual (Pub. 100-06), Ch. 4 § 20.1
Number of Demand Letters
20.1 - Number of Demand Letters
(Rev. 316, Issued: 05-24-19, Effective: 10-01-19, Implementation: 10-07-19)
In general, the contractor sends one overpayment Initial (1st) demand letter to a provider or supplier.
The contractor shall have at all times access to copies of the demand letters generally housed in the case
file, bulk PDF, or in HIGLAS. When the demand letter has been sent and returned as undeliverable, the
contractor shall attempt to locate the provider or supplier (see Chapter 4, §10). If the contractor is
unable to locate the provider or supplier and the overpayment is eligible for referral to the Department of
Treasury, the contractor shall immediately send the ITR demand letter, which shall include the intent to
refer language.
Where a repayment schedule has been established after the Initial (1st) demand letter has been sent
and the provider or supplier defaults on the repayment schedule, the contractor shall count that 1st
demand letter as one of the two letters (1st and ITR) normally sent to an overpaid provider or supplier.