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Overpayment ReopeningsOverpayment Reopenings

If you identify a claim or service in which Medicare paid in error and are not refunding with a check, use the appropriate form to submit your request.

Overpayment Recovery Request: Non-MSPPDF

Overpayment Recovery Request: MSPPDF

Fax the request(s) to:

  • 1.615.664.5916 (KY)
  • 1.615.664.5926 (OH)

NOTE: Type directly into the required fields on the Overpayment Recovery Request Form, then print. Illegible forms may cause a delay in processing.

  • Ensure the following information is included:
    • Provider Information
    • Patient Name
    • Patient's Medicare ID Number
    • Claim Number
    • Date(s) of service
    • Procedure Code
    • Refund Amount
    • Select the appropriate Reason for refund

For refunds that are MSP-related, include the EOB or the payment allowed and paid by the primary insurer.

For Non-MSP Reasons that require information to be updated to the claim, include a copy of the updated CMS-1500 Claim Form.

NOTE: Providers may also use myCGS to submit an Overpayment Recovery Request form. Click here for more further instructions.

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