QUEST Integration - Refunding HMSA

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

On occasion you may discover that you have received an overpayment caused by the wrong patient's name being used, the service being billed under an incorrect member number, or another carrier having paid the claim in full. When you identify an overpayment occurred, you must return the overpayment to us within 60 calendar days after the date on which the overpayment was identified.

You may refund HMSA's Plan for QUEST Integration members in one of two ways:

• Send a copy of your payment report highlighting the claim, indicating that you would like us to deduct the payment from an upcoming payment check and the reason for the deduction. (For administrative ease, most providers prefer to handle deductions in this manner.)
• Send a check. Be sure to include the following information so that we may apply the refund to the correct claim, or attach a copy of the Report to Provider that included the claim.
  • Patient name
  • QUEST Integration member number
  • Date of service
  • Date of payment
  • The reason the payment is being refunded

Note: If you are refunding a payment because of an unreported other insurance payment, the refund amount is the lesser of the QUEST Integration payment or the other insurance payment. Any other refund amount will be returned to you and the correct amount will be adjusted from a forthcoming RTP.

• If you send a single check to refund for more than one patient, please itemize the refund to include all of the above information for each patient.

The HMSA QUEST Integration payment check should be deposited by providers since it may include payments for claims that are correctly paid. The check should be returned to us to void the payment only if all the claims paid on the check are being refunded. Returning the check when only one or two claims are affected will require that all the listed claims be reprocessed, even if the original payment for the claim was correct.

Please mail your check payable to HMSA to:

HMSA - QUEST Integration Operations
P.O. Box 3520
Honolulu, HI  96811-3520

Recovery Requests

When we discover that an error was 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 you a letter informing you of the overpayment. If you believe that our determination is incorrect, please contact HMSA's QUEST Integration Provider Service at the phone number listed in the letter or provide us with a written explanation why you believe our determination is incorrect. Your response should be sent to:

HMSA - QUEST Integration Operations
P.O. Box 3520
Honolulu, HI  96811-3520

If we do not hear from you within 60 days of the date of our letter, we will deduct the undisputed overpayment from an upcoming payment check and report it on your Report to Provider.

Revision History