For refund claims with seven reporting periods or more, or many line items, submit a written claim. On Question 2, check the first box.Also write on the form: "I want all overpayments on my record to be waived, even the amounts you have already collected." Place the completed Form 203 on top of your tax return. Documentation –Submit all medical records and itemized statements with the initial claim, to ensure adjudication in a timely manner. Members receiving overpayment letters must respond promptly, as they are given four weeks to do so. Make sure to fill out Annex B in your overpayment letter within the deadline provided even if you file a grievance.

Overpayment Letter To Customer In Arizona

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