As you may know, Point32Health takes the necessary steps to recover negative balances, which are created when a claim has been overpaid and is subsequently retracted/re-adjudicated. Reasons why a claim may be retracted include, but are not limited to:
- Duplicate payment
- Payment to the wrong provider
- Payment for the wrong member
- Retroactive termination of a member
- Overpayment identified through internal or external audits
- Payment adjustment from rate correction (e.g., claim should have been paid at contract rate)
Negative balances are typically recovered using other claims payments to offset the amount. If there are insufficient claims payments, a negative balance may be transferred to other claims systems within Point32Health and its affiliates to offset the amount. For example, a negative balance related to a Tufts Health Plan product member may be resolved via Harvard Pilgrim claims. Alternatively, the provider may submit a refund check to the plan to resolve a negative balance.
Negative balances that cannot be settled through offsetting claims payments or a refund check may be placed in a collection status.
For more information about negative balances, refer to the Negative Balance policy of Harvard Pilgrim’s commercial Provider Manual and the Claims chapter of the Tufts Health Plan commercial Provider Manual.