Handling Overpayments and Refunds

TriWest Healthcare Alliance’s claims processing subcontractor, Wisconsin Physicians Service (WPS) is responsible for collecting refunds from TRICARE providers in the West Region. These refunds can be caused by calculation errors, duplicate payments, provider errors in claim submission, etc. 

Provider Identified Refunds
If you receive an overpayment for a TRICARE West Region claim; i.e., for a TRICARE Prime, TRICARE Standard or TRICARE Extra beneficiary, TriWest/WPS requests that you send your refund or return our check to the following address:

TRICARE Finance Refunds – West Region
WPS
P.O. Box 77030
Madison, WI 53707-1029

To ensure the refund is credited to the correct claim, when returning payments, please include the Provider Explanation of Benefits (EOB). If this is not available, please include the TRICARE claim number, Sponsor’s Social Security number, beneficiary’s name, refund calculation, and any other pertinent information.

Recoupment Letters and Offsets
When an overpayment of a claim is identified by WPS, the finance department will send a recoupment letter requesting refund of the overpayment. The first letter is sent out when the overpayment is established. A second letter is mailed at 30 days if the refund has not been received.

After 60 days, if the refund is not received, an offset flag is set in WPS’s refund system. This offset will cue the payment system to deduct the amount you were overpaid from the next payment processed under your provider ID. With the offset remittance, you will receive a copy of the original recoupment letter. You can use the recoupment letter to apply the offset to the claim being recouped. 

It’s important to promptly respond to recoupment requests. If you submit a refund on day 55, mailing and processing may not have occurred by the time an offset is taken at the 60-day mark. This may lead to a duplicate collection. WPS will refund the duplicate collection, but a timely refund from you will eliminate the confusion and extra workload for both entities. 

Administrative Review
If you receive a refund request and disagree, you can request an administrative review of indebtedness to review the refund request. You should follow the protocol set in the TRICARE Operations Manual.

According to Chapter 11, Section 4 of the TRICARE Operations Manual, if you request an administrative review of your indebtedness, WPS will review the documentation contained in the case file and any additional information or documents that you submit. You should submit your request immediately and send it to:

TRICARE West Region
P.O. Box 77029
Madison, WI 53707

Following the review, TriWest will respond to you. TriWest’s response will describe the documentation reviewed and will explain the reviewing party’s rationale for the decision to pursue or terminate the recoupment action. If the review results in a decision to recoup the overpayment, you will be advised that full payment or other satisfactory arrangements for repayment must be made within 30 days. Your request for an administrative review of indebtedness does not result in suspension of the accrual of interest from the date of the initial demand letter.

For more information about overpayments and refunds, refer to the TRICARE Operations Manual at www.tricare.mil or call 1-888-TRIWEST (888-874-9378).