Overpayment Recovery Policy

Priority Health handles recovery of overpayments to providers according to the situation that created the overpayment and the time frame between when the payment was made and when the overpayment was identified:

Member Retro-Terminations
Recovery will be limited to 12 months from date of payment. Member liability exists.

Coordination of Benefits
Recovery will be limited to 12 months from date of payment. Member liability may exist.

Inaccurate Payment
This includes duplicate payment, system set-up error, claim processing error, claims paid to wrong provider. Recovery will be limited to 12 months from date of payment.

Identified Through a Medical Record Audit
Recovery will be limited to 18 months from date of payment. Time period starts from audit notification date.

Fraud and Abuse
Recovery time period will be the statute of limitations.

For more information, providers should review their Priority Health contracts.