Claim Overpayments

Claim overpayments can occur for a number of reasons, including, but not limited to: a change to member eligibility; a billing error; or invalid fee schedule information. When claim overpayments occur, regardless of the reason, we will take action to recover the overpayment amounts in accordance with the Health Claim Authorization, Processing and Payment Act (HCAPPA), P.L.2005 c.352.

• Returning Horizon Identified Overpayments

  When Horizon identifies that a claim overpayment has been made, we will initiate a claim adjustment and generate a refund request letter to the payee. This letter will provide the details of the adjusted claim, indicate the overpayment amount to be recovered and provide instructions for the return of the overpayment amount.

  If you receive a refund request letter, it will include instructions to mail the overpayment, along with a copy the letter, to:

  Horizon BCBSNJ
  PO BOX 11595
  Newark, NJ 07193-1595

• Returning Provider Identified Overpayments

  Billing providers that identify a claim overpayment, may mail the overpayment to the appropriate address below. Along with the overpayment, please include the following details:

  • Patient Name
  • Date of Service
  • Member ID Number
  • Claim Number

  For overpayments made on claims for:	Mail overpayments to:
  Horizon BCBSNJ members	Horizon BCBSNJ PO BOX 11596 Newark, NJ 07193-1595
  Federal Employee Program (FEP) members	Horizon FEP PO Box 11594 New York, NY 10087-1594
  Braven Health℠ Medicare Advantage members	Braven Health PO Box 825488 Philadelphia, PA 19182-5488
  Horizon NJ Health NJ FamilyCare or Horizon NJ TotalCare (HMO D-SNP) members	Horizon NJ Health Member/Provider Correspondence PO Box 24077 Newark, NJ 07101-0406

Please Note:

With the exception of the Horizon NJ Health address, the addresses above should ONLY be used to return overpayments. Claim submissions, inquiries, or other pieces of correspondence should NOT be submitted to these addresses.