Forms
- Immediate Offset Form (Use this form to request an offset of a specific demand letter or a provider level offset for current and future overpayments)
- Voluntary Overpayment Refund Form - Part A (Use this form only when refunding with a check)
- Medicare Credit Balance Report (CMS-838)
- Medicare Credit Balance Correction Form
- Extended Repayment Schedule (ERS)
- Accelerated/Advance Payment Request Form
- COVID-19 Accelerated/Advance Payment Form
- Stop Payment Affidavit
Reviewed: 12.01.22