Overpayments

This information is intended to help Individual Providers understand a Vendor Overpayment Notice received from the DSHS Office of Financial Recovery (OFR), and determine next steps.

I received a Vendor Overpayment Notice from OFR; what do I do next?

Review the notice and the specific payments that are on the overpayment claims detail page, and consult your records.
To make payment arrangements please contact OFR directly at:

  • 1-800-562-6114
  • (360) 664-5919
  • TTY WA 1-800-833-6388

To send a payment to OFR, follow the instructions on your Vendor Overpayment Notice. Funds should be mailed to the address shown on page 2 of your notice. Do not send funds to PPL/IPOne.

I received a notice from Office of Financial Recovery, but I don't think I owe the overpayment. What is the process to request an Administrative Hearing?

The overpayment notice contains instructions to request an administrative hearing. You must request an administrative hearing within 28 days of receiving the overpayment letter. Follow the instructions to request a hearing, including sending your request to Office of Financial Recovery (OFR) via certified mail*, requesting a hearing and stating why you disagree with the overpayment. Include a copy of the overpayment notice you received.
When OFR receives your request, it will be sent to the Office of Administrative Hearings for scheduling. The Office of Administrative Hearings will schedule a hearing and send you a notice of the hearing date. This will include instructions on how to appear. Some hearings are in person and some are over the phone. The hearing does not require attorney representation. After hearing the case, an administrative law judge will make a decision regarding the overpayment.

*Note: Certified mail is a USPS service which provides proof of mailing. Please go to your Post Office to purchase certified mail service.

I made a payment arrangement and sent in my first payment. How will I know how much I still owe on my overpayment?

You will receive a monthly statement from OFR which will display your current balance due. If you believe that you have sent in funds, but it is not reflected on your statement, it may be due to payment processing time. If you do not see it on the next statement or are not receiving a monthly statement, please contact OFR.

Possible Overpayment Reasons

When an overpayment is created, there are specific possible reasons this might have occurred. These reasons are captured in codes that appear on your Overpayment Notice. Depending on the reason code showing in your notice, you may need to speak with the client's case manager about what authorization activity has occurred, or review your timesheet submission and adjustment history in IPOne.
The following is a list of the Overpayment Reason codes and their meanings.


Code

Description

P1

DSHS overpaid you for goods or services you did not provide. 

P2

DSHS overpaid you for goods or services that were authorized in error.

P3

DSHS overpaid you for goods or services that you were not eligible to provide.

P4

DSHS overpaid you for services that the client was not eligible to receive.

P5

DSHS overpaid you for goods or services that were paid at the incorrect rate. You received an erroneous payment.

P6

You received a duplicate payment.  DSHS overpaid you for goods or services that were paid more than once for the same service.

P7

A previously paid claim was adjusted by you or by someone on your behalf, indicating that you were overpaid for goods or services. You received a duplicate or erroneous payment.

P8

DSHS overpaid you for goods or services that you were not eligible to provide.  You claimed for dates of services when the client was in the hospital or other institution.

Overpayment Notice Claim Detail

Other information found on Page 3 of the Overpayment Notice

Client Name
Authorization number

Client name and authorization number informs the provider which client and authorization the overpayment is related to.

TCN

Transaction Control Number - assigned by IPOne as the transaction reference number in the payment system. Each paid timesheet has its own TCN number.

Month of Service

The month of service the overpayment originated. These are the days you submitted on your timesheet.

Payment Date

The pay date you received the payment from IPOne. This is not the same as Month of Service.

Check/EFT number

This is the Earnings Statement number related to the payment you received. This number can be found on the timesheet search screen in IPOne.

Overpayment Amount

The amount of the overpayment for each timesheet.

Review Timesheet Submissions

OFR Staff cannot help Individual Providers with questions about either timesheet submissions to IPOne, or authorization activity completed by case managers. For assistance in reviewing the timesheet submission or adjustment which created an overpayment, you can contact the Individual ProviderOne (IPOne) Call Center.

  • Call the IPOne Call Center at 844-240-1526
  • Advise the agent you received an overpayment notice from DSHS and you would like help in reviewing the timesheet submission(s) which generated the overpayment. Make sure you have your Overpayment Notice ready with the relevant claim detail.
  • PPL agents can assist you with locating and reviewing the timesheet submission and/or adjustment which created the overpayment.

IPOne Training Materials

Reviewing the training materials published regarding timesheet submission may also help avoid future overpayments.

Training is available if you need assistance with correctly completing and submitting timesheets to IPOne, as well as completing timesheet adjustments. Ask the PPL call center agent to connect you with a Program Support Specialist who can schedule an IPOne training session for you.