This form is used when there has been an improper payment to the correct provider. This form is NOT used for overpayments of foster care funds.Providers have the option to submit a Request For Extended Repayment Schedule (ERS). A complete ERS request should be submitted immediately. It's important that you also include a completed refund form. This completed form allows us to apply the refund to the correct claim overpayment. When you identify a Medicare overpayment, use the Overpayment Refund Formto submit the voluntary refund.

Overpayment Letter To Customer In Michigan

Description

Related forms

Show more info

Form Rating

Form popularity

More info

Trusted and secure by over 3 million people of the world’s leading companies