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Phia Group Media


Overpayment Success Story: Dialysis Claim

By: Michael Branco

A dialysis claim was adjudicated at the regular out-of-network rate instead of the dialysis carve-out rate of 130% of Medicare. After unsuccessful attempts to recover the overpayment, the TPA, with expectations dashed, asked The Phia Group to attempt to make an attempt at recovery. After four months of arguing, back-and-forth correspondence, and what seemed like an endless amount of repetition, the provider finally agreed to refund the $137,500 overpayment based on the language in the plan document.