The Claims Analysis and Recovery Department (CAR) is responsible for reviewing paid claims to identify overpayments made to a provider. CAR also reviews high dollar claims prior to the claim being paid to ensure payment accuracy. CAR partners with United Health Group (UHG) Recovery Services and UHG Field Service to manage the recovery process and ensure the recovery of overpayments occurs as well as eliminates possible duplication of recovery efforts. CAR provides oversight to AIM HealthCare, an on-site credit balance vendor engaged in recovery activity on behalf of Medica.
Medica's CAR department identifies an overpayment
After an overpayment has been identified, CAR sends a letter to the provider indicating the overpayment. The letter gives the provider 30 days to respond if they believe the overpayment identified is incorrect. If after 30 days we do not receive a response, an adjustment request is sent to UHG Field Service to complete the adjustment. The provider will see the adjustment on the next Provider Remittance Advice (PRA).
Provider identifies an overpayment
If a provider identifies an overpayment you should complete the Adjustment Request Form and submit supporting documentation to:
Medica
PO Box 30990
Salt Lake City, UT 84130
The Adjustment Request Form and documentation will be processed and the adjustment will appear on the next PRA.
Download Adjustment Request Form.
Provider sends a refund check To send a refund check use the following process:
- Provider identifies an overpayment on a claim and issues a refund check to Medica. The check is sent to San Antonio with supporting documentation (i.e. Claims Adjustment Form and any attachments).
- Field Service in Duluth processes the adjustment based on the supporting documentation.
- Provider will see the adjustment on the next PRA.
Download Claims Adjustment Form.
Provider returns a Medica check
To return a check to Medica use the following process:
- Provider receives payment from Medica and after review of the payment, determines that payment has been made in error.
- Provider should send the Medica check back to San Antonio with supporting documentation indicating the payment was in error.
- Medica will void the check and re-issue the correct amount if applicable.
Providers are able to obtain additional information, including downloadable forms, under the Adjustment and Resubmission Processes section of Claims Tools and Forms and under the Recovery Processes section of General Tools and Forms. Any further questions can be forwarded to (952) 992–3039.
View Claims Tools and Forms
View General Tools and Forms.
Return to Billing and Reimbursement.