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

