Post Payment and Retroactive Recovery Clause Samples
The "Post Payment and Retroactive Recovery" clause establishes the right of a party to recover payments that were made in error or that later become unjustified. In practice, this means that if an overpayment is discovered after funds have been disbursed—such as due to a billing mistake or a subsequent determination of ineligibility—the paying party can demand repayment or offset the amount from future payments. This clause is essential for protecting parties from financial losses due to administrative errors or changes in circumstances, ensuring that payments reflect only what is properly owed.
Post Payment and Retroactive Recovery. Pharmacy The Federal or State, and or their designee, will be vested with the sole responsibility to collect any reimbursement for Benefit Package services obtained from TPHI.
Post Payment and Retroactive Recovery. Non Pharmacy The State, and/or its designee, will also be vested with the responsibility to collect any reimbursement for Benefit Package services obtained from TPHI. In no instances may an Enrollee be held responsible for disputes over these recoveries. A recovery shall not exceed the encounter data paid claim amount. The State will continue to identify available TPHI and post this information to the eMedNY System. The TPHI information will appear on the Contractor’s next roster and TPHI file. The Contractor will have six months from the later of the date the TPHI has been posted (eMedNY transaction date) or the Contractor’s claim payment date to pursue any recoveries for medical services. All recoveries outside this period will be pursued by the State. For Federal or State-initiated and Federal or State-identified recoveries, the Federal or State Government will direct providers to refund the State directly. In those instances where the provider adjusted the recovery to the Contractor in error, the Contractor will refund the adjusted recovery to the State.