Identifying Beneficiary Information in Overpayment Recoupment/Offset Situations

There are a couple methods for obtaining information related to overpayment recoupment/offset. One method is utilizing the Remittance Advice (RA), accessible under the Provider Adjustment (ADJ) Details Section and PLB Reason Codes. The PLB REASON CODE field specifies the provider-level adjustment reason code, with PLB code WO signifying an offset due to a prior overpayment in accounts receivable. A reference number, comprising the original ICN and Medicare ID, is listed for tracking purposes.

Providers, affiliated with various NPIs but sharing the same Tax Identification Number (TIN), may experience withholdings from one provider (PTAN) to cover the overpayments of another provider (PTAN). In these instances where funds are reclaimed by TIN, and the supplier cannot ascertain the PTAN subject to recoupment, contact the Supplier Contact Center (SCC) for the respective jurisdiction. Suppliers may need to leave a message and await a callback.

Example: Supplier 123 PTAN in California has an offset for supplier 345 PTAN in Florida. Both share the same TIN, but supplier 123 cannot locate the details pertaining to the offset in their accounts receivable for reconciliation. Contacting the SCC is advised for obtaining this specific information.

An alternative method to gather such information is through the Noridian Medicare Portal (NMP), specifically the Overpayments function. This tool enables suppliers to access a summary of claims potentially causing overpayments. The Overpayment Results inquiry in the NMP offers details on the claims leading to overpayment, along with the actions taken to address the overpayment. Suppliers can identify offsets and link them to the beneficiary’s name. To initiate an inquiry:

  1. Navigate to the Financials tab.
  2. Select the Overpayment Results tab.
    • Enter Provider/Supplier details for overpayment.
    • Input Overpayment Letter Number and/or Claim Number (CCN).
    • Choose to view the most recent 100 results or download a CSV file.
  3. The results provide a summary.
    • Click on the plus symbol (+) next to CCN to access Beneficiary Name, Claim Number, Date of Service, and Overpayment Amount
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