Effective Date: July 1, 2022

Previous Policy

Submit or send an overpayment referral to the DWS overpayment unit for overpayments caused by Suspected Intentional Program Violation and untimely reporting of other health insurance for CHIP issued months.

1. Agency and Inadvertent Errors

When improper CHIP coverage occurs due to an agency or an inadvertent error, correct the error and send the proper notice.

2. Suspected Intentional Program Violation (SIPV) Errors

When improper CHIP coverage occurs because of a SIPV error or untimely reporting on the part of the enrollee, submit an overpayment. See Section 806-1 .

3. Overpayment is calculated and collected for monthly health plan premium paid in error.

o Error amount is calculated for each ineligible child(ren) and for all ineligible CHIP month(s).

o Coordination of claims is the responsibility of the CHIP health plan and customer.

(See Section 220-1 for definition of Health Insurance Coverage or Plan))

4. There is a 3-year statute of limitations on the collection of any overpayment.

a. Overpayments will not be adjudicated and collected on from periods older than 3 years prior to the date the Notice of Agency Action (NAA) is mailed to the individual.

b. The overpayment worker will determine which part of the overpayment does not exceed that time frame.

Example –

Member’s overpayment dates from March 2010 to March 2016

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations for the overpayment consists of January 2019 through the current date.

Because the overpayment period falls outside the statute of limitations period, we cannot collect anything on this.

Example –

Member’s overpayment dates from March 2014 to March 2020

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations period for overpayment consists of January 2019 through today.

The overpayment period consists of any overpayment amount accrued from January 2019 to March 2020. March 2014 through December 2018 are outside the Statute of Limitations and are not allowed.

Example –

Member’s overpayment dates from March 2019 to January 2022

The overpayment worker sends the NAA on January 26, 2022 to cover this overpayment period.

Based on the mail date, the 3-year statute of limitations period for overpayment consists of January 2019 through today.

The overpayment for March 2019 to January of 2022 can be collected because it is within the statute of limitations period.