Common use of Recoveries Clause in Contracts

Recoveries. ‌ All claim lines with a payment recovery or other adjustment to the Original claim line related to TPL, accident recovery, or provider audit recoveries must have the Void Reason Code populated (#118), including for all Voids and Replacements. Voids and/or Replacements for provider audit recoveries should include all overpayments recovered or otherwise adjusted as a result of program integrity fraud, waste and abuse controls, including but not limited to provider audits, surveillance and utilization reviews, investigations, post-payment claims edits, algorithms, and provider self- disclosures.