Section 140.25  Overpayment or Underpayment of Claims

a)         When the Department, the provider, or the designated alternate payee has determined that an overpayment has been made, the provider or the alternate payee shall reimburse the Department for the overpayment.  The Department shall recover overpayments made to or on behalf of a provider that result from improper billing practices.  Such recovery may occur by setoff, crediting against future billings or requiring direct repayment to the Department.

b)         When a provider believes it has received an underpayment for  services, it may request Department review.  The request must be received by the Department within 12 months after the date payment was authorized.  If the review reveals an underpayment was made, the Department shall pay the additional amount due.  If the review reveals an overpayment was made, the provider, or the designated alternate payee, shall refund the amount of the overpayment.

(Source:  Amended at 31 Ill. Reg. 2413, effective January 19, 2007)