General
What is an overpayment?
When YSA has paid for something that has not yet been validated as an eligible expense.
Sharon had a duplicate claim, causing an overpayment. Her balance is $1200. Sharon submits a new claim for $600. The new claim is then applied to the OP (clearing the OP). Her available balance was untouched. This is an example of what recovery method?
Submitting a new claim
How long does it take an overpayment to clear if a participant pays is back online?
2-3 business days
Jack has an available balance of $12,000. He has an OP of $500. Jack sends in a check of $300. Jack submits a new claim for $200. What is his new available balance?
$12,300
What is a true overpayment?
If the participant's account pays more than the goal (available) amount of the account
Joshua has a $3,000 available balance. He swiped his card at the doctor's office for $1,000. The claim later got denied for no documentation. Joshua then submits his claim with documentation the has the 5 requirements (ppt name, provider name, description of service, date of service, and amount due). This is an example of what recovery method?
Resubmitting the claim
How long does it take for an overpayment to clear is the participant mails a check?
up to 6 weeks
Jack has an available balance of $12,000. He has an OP of $500. Jack sends in a check for $500 to go towards the OP. 3 days after sending in the check, Jack submits a new claim for $500. Is his overpayment cleared? And what happens to the check he sent in?
Yes. His check is sent back to him.
What if the participant received a cash refund from the provider?
A ticket needs to be started to put the account in overpayment, and ppt has recover the overpayment (pay it back or submit new claim)
When a participant goes online or mails in a check to recover an overpayment, what are they doing?
Paying it back
What needs to be included on a check, if a participate decides to mail in a check?
claim number and last 4 of SSN
John has an available balance of $10,000. He submits a claim for $1500 worth of expenses, making his balance $8,500. This claim was later denied, placing his account in OP. John decides to pay the full OP back online. How much is the OP and what is his new available balance?
OP= 0
New Available Balance= $10,000