Commonwealth of Massachusetts 
Executive Office of Health and Human Services 
Division of Medical Assistance 
600 Washington Street
Boston, MA 02111


MassHealth 
All Provider Bulletin 112 
December 2000 

TO: All Providers Participating in MassHealth 

FROM: Wendy E. Warring, Commissioner 

RE: Overpayment Policy 

Background

Providers participating in the MassHealth program are required to return 
overpayments to the Division within 60 days of their receipt. 

Overpayments are payments you receive from MassHealth to which you are not 
entitled. For example, an overpayment occurs if you have received payment for a 
claim that has been paid to your provider number in error, paid for the wrong 
member, or paid in full or in part by another insurer (for example: Medicare, 
private insurance, or Worker’s Compensation). Refer to 130 CMR 450.235 for 
additional information regarding types of overpayments. 

Administrative Fines for Failure to Comply 

The Division may impose administrative fines against providers who do not return 
overpayments classified as credit balance funds within 60 days of their receipt 
(see 130 CMR 450.238). To avoid such administrative fines, you should routinely 
conduct periodic reviews of financial records to detect MassHealth overpayments. 
It is illegal to keep payments to which you are not entitled. 

Administrative Fine Free Period

From the time you receive this bulletin until February 1, 2001, the Division 
will waive its right to impose fines against a provider who returns an overdue 
overpayment. 

Returning Overpayments to the Division 

Providers must request a void in order to return the full payment when an 
overpayment has occurred. Do not send checks. 

To request a void, circle the claim line to be voided on a photocopy of 
the remittance advice. Send the photocopy to the following address with a signed 
letter indicating the reason you are requesting the void. 

Unisys 
Attention: Voids 
P.O. Box 9105 
Somerville, MA 02145 




MassHealth 
All Provider Bulletin 112 
December 2000 
Page 2 

Returning Overpayments to the Division (cont.)
 
After the void has been processed, the remittance advice will display a 
negative amount owed to the Division for that claim. This amount will 
be deducted from future payments until the full amount of the void has 
been recovered. 

Returning Partial Overpayments to the Division 

If you would like to return a partial overpayment of a claim to the Division, 
submit an adjusted claim according to section 5.6 of your billing instructions. 
The Division must have complete and accurate information, as outlined in these 
instructions, to correctly adjust your payment history. Helping the Division 
maintain a correct claims history will benefit you particularly during audits 
and record reviews. 

Submit your adjusted claim to the following address. 

Unisys 
Attention: Adjustments 
P.O. Box 9105 
Somerville, MA 02145 

Cover Letter

To ensure that these overpayments are not assessed a fine, include a 
cover letter with your voids or adjustments that includes: 

• a statement that you are returning these overpayments in response to All 
Provider Bulletin 112;. 
• the reason for the overpayments; and 
• if you know that these claims are under current inquiry by any 
government agency or contractor, information about the nature of 
the inquiry and the name of the agency or contractor. 

Questions

Contact MassHealth Provider Services at (617) 628-4141 or 1-800-325-5231 with 
any questions you have about this bulletin.