Reimbursing HMSA

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 three ways:

• Payment Recoveries can be submitted on HHIN+ using the Claim Inquiry form. To access the Claim Inquiry form, navigate to the Claim Additional Details screen, which can be reached through the Claims Search, RTP (Report to Provider), or Claim Inquiry Summary (for existing claim inquiries). For more information, please refer to the HHIN+ User Guide [PDF].

• Providers may call or write a Provider Services Representative and ask that a deduction for the incorrect payment be made on the next Report to Provider. (For ease of administration, most providers prefer to handle deductions in this manner.)
• Providers may send us a check for our incorrect payment, if they prefer to reimburse HMSA directly. So that we may correctly credit the patient’s account, the following information should be included:
  • Patient name
  • HMSA member ID number
  • Date of service
  • Date of payment
  • The line of business (e.g., QUEST, FEP, private business, etc.)
  • The reason the payment is being returned

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

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:

HMSA-Cashier

P.O. Box 4720

Honolulu, HI  96812

Recovery Requests

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.

Revision History