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
(Use this form only when refunding with a check)
- Overpayment Recovery Request: MSP
- Overpayment Recovery Request: Non-MSP
- Extended Repayment Schedule (ERS)
- Accelerated/Advance Payment Request Form
- COVID-19 Accelerated/Advance Payment Form
- Stop Payment Affidavit