Change in Recoupment Offset Process

On August 1, 2011, TriWest, in conjunction with Wisconsin Physicians Service Insurance Corp. (WPS), is changing the recoupment offset process to the 9-digit tax identification number (TIN) when there are no payable claims at the 18-digit provider identification level. The 18 digit identifier consists of the TIN, the location ZIP code and a sub identification number. In the current process, WPS’s claims system will search for claims to be paid under the 18-digit identifier for the group or facility to match against open recoupments. If there are claims, the claims will be offset against the recoupment at the 18-digit identifier level. If there are no claims found, no offset is taken. In the new process, if the claims system does not identify claims at the 18-digit identifier level, it will then search for claims to be paid at the 9-digit TIN level. Any claims processed under the 9-digit TIN would be offset against the recoupment until a zero balance is reached. When a recoupment is determined to be valid, a letter is first sent to the provider requesting the money within 30 days. If the money has not been returned after 30 days, another letter is sent to the provider. If after 60 days, the recoupment is still showing a balance, offsets will start to occur.

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