If a determination results in an overpayment, the amount of the overpayment will be included in the determination letter. Please download the form, complete each field and print.Include the form with your refund so we can properly apply the refund and record the receipt. We have identified the following overpayment and are in good faith voluntarily refunding all monies collected in error. Adjustment Process for Overpayments​​ Via an overpayment letter, explaining the cause of the overpayment and requesting a refund. When you receive an overpayment, call the insurance company to confirm that the extra money is a true overpayment. Complete the Overpayment Notification form. Instructions are in a separate tab on indicate how to complete the form.