On occasion providers may discover that they received an overpayment caused by a billing error such as the wrong patient's name being used, the service being billed under an incorrect member ID number or another carrier having paid the claim in full. When such an overpayment occurs, providers may reimburse HMSA in one of two ways:
Note: If you are refunding HMSA because you received payment from a TPL carrier, please also include:
Providers sending a single check to cover the refund for more than one member should itemize the refund to include all of the above-referenced information for each member.
Checks should be mailed to:
P.O. Box 4720
Honolulu, HI 96812
When HMSA discovers that an error has been made in processing a claim, or when HMSA was incorrectly billed for services that should have been billed to a liable third party, we will send a letter informing the provider of the overpayment. If the provider believes our determination is incorrect, the provider can contact HMSA's Benefits Recovery Unit at the phone number listed on the letter, or provide us with a written response explaining the reason the provider believes our determination to be incorrect. The response should be sent to:
Benefits Recovery Unit
HMSA - Claims Administration Dept.
P.O. Box 860
Honolulu, HI 96808
If we have not heard from the provider within 60 days of the date of our letter, we will deduct the undisputed overpayment from the provider's next remittance.
|Rev#:||Date:||Nature of Change:|
|1.0||03/14/2007||This document consolidates versions for multiple provider types into a single document|
|1.1||10/18/2007||Revised text throughout to reflect third-person instead of second-person usage.|
|1.2||07/24/2008||Deleted 6th Floor and Membership and Enrollment Dept from refund address.|
|1.3||02/24/2010||Removed from IV Therapy indices.|
|1.4||05/16/2012||Added: "Note: If you are refunding HMSA because you received payment from a TPL carrier, please also include:, Name of the carrier, Onset date of the injury, Type of Accident (WC, NF, etc.), Diagnosis involved" and changed "Other Party Liability" to "Benefits recovery".|
Files that are in PDF format can be viewed using the free Adobe Reader or another PDF-reader application.
Need a language interpreter?
ʻŌlelo Hawaiʻi | Bisaya | 繁體中文 | Ilokano | 日本語 | 한국어 | ພາສາລາວ | Kajin Ṃajōḷ | Lokaiahn Pohnpei | Gagana Sāmoa | Español | Tagalog | Tonga | Foosun Chuuk | Tiếng Việt