Get Wps Medicare Part B Non-msp Overpayment Notification Form 2020-2025

This guide will help you navigate the process of filling out the WPS Medicare Part B Non-MSP Overpayment Notification Form online. By following these steps, you can ensure that your overpayment notification is completed correctly and submitted efficiently.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to access the form and open it in your editor.
2. Identify the contact information section. Here, you will need to provide your contact name and phone number.
3. Specify the state by selecting your relevant location from the provided options. Remember that fax numbers vary based on states, so confirm yours matches.
4. Select a reason for the overpayment from the list provided. Choose the option that best applies to your situation, ensuring only one selection is made to avoid confusion.
5. If applicable, fill out the billing error section. Provide a brief explanation of any errors experienced, as well as the original check number for duplicate payments.
6. Complete the billing provider information fields, including the billing provider name, tax ID number, PTAN (Provider Transaction Access Number), and NPI (National Provider Identifier) number.
7. In the beneficiary information section, enter the HICN (Health Insurance Claim Number), along with the date(s) of procedure, service code, amount overpaid, claim number, and date(s) of service.
8. Include the procedure code and total amount overpaid in the specified fields.
9. Finally, attach any relevant documentation that supports your claim. This documentation may be necessary for a thorough review of your notification.
10. Once all fields are completed accurately, you may choose to save your changes, download the form for your records, print it, or share it as needed.

Complete your WPS Medicare Part B Non-MSP Overpayment Notification Form online today!