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Overpayment Recovery Procedures

When an overpayment recovery effort has been initiated, the provider will receive an "Initiation of Overpayment Recovery" letter. If the refund is not received within 30 business days from the initial letter, a second notice will be sent. If the refund is not received within 45 days from the initial letter, a third notice will be sent.

MHN does not initiate overpayment recovery efforts more than 12 months after the original payment, unless the efforts are based on fraud or other intentional misconduct, or initiated at the request of a self funded plan.

No determination of recoupment, denial, or overpayment recovery is based on extrapolation or statistical sampling.

MHN does not require members/providers to repay contested overpayments before an actual appeal is rejected or a final administrative decision or a court or arbitration order is rendered.

MHN does not retrospectively deny, adjust, or re-code overpayments made to providers without a refund being obtained, unless the provider specifically requests this method.

Practitioners may send overpayments to:

MHN
P.O. Box 9088
San Rafael, CA 94912
Attention: Finance