Claim Overpayments

Claim overpayments can occur for a number of reasons, including, but not limited to: a change to member eligibility; a billing error; or invalid fee schedule information. When claim overpayments occur, regardless of the reason, we will take action to recover the overpayment amounts in accordance with the Health Claim Authorization, Processing and Payment Act (HCAPPA), P.L.2005 c.352.

  • Horizon-identified Overpayments

    When Horizon NJ Health identifies that a claim overpayment has been made, we will initiate a claim adjustment and generate a refund request letter to the payee. This letter will provide the details of the adjusted claim, indicate the overpayment amount to be recovered and provide instructions for the return of the overpayment amount.



    If you receive a refund request letter, it will include instructions to mail the overpayment, along with a copy the letter, to:



    欧宝体育登录注册
    Member/Provider Correspondence
    PO Box 24077
    Newark, NJ 07101-0406

    Provider-identified Overpayments

    If you, the billing provider, identify a claim overpayment, please mail the overpayment amount to the address above. Please include the following details along with any self-identified overpayment amount you mail to us.


    • Patient Name
    • Date of Service
    • Member ID Number
    • Claim Number

  • If you identify a claim overpayment for a patient enrolled in another Horizon plan/product, the overpayment may be mailed to the appropriate address below. Along with the overpayment, please include the following details:


    .
    • Patient Name
    • Date of Service
    • Member ID Number
    • Claim Number

    For overpayments made on claims for: Mail overpayments to:
    Horizon BCBSNJ commercial & ASO members Horizon BCBSNJ
    PO BOX 11596
    Newark, NJ 07193-1595
    Federal Employee Program (FEP) members Horizon FEP
    PO Box 11594
    New York, NY 10087-1594
    Braven健康℠医疗保险的优势embers Braven Health
    PO Box 825488
    Philadelphia, PA 19182-5488

    Please Note:


    The addresses above should ONLY be used to return overpayments. Claim submissions, inquiries, or other pieces of correspondence should NOT be submitted to these addresses.