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Refund Check for Demand Letter Voluntary Refunds

If you identify a Medicare overpayment and are voluntarily refunding with a check, use the Overpayment Refund FormPDF to submit the request. This will ensure we properly record and apply your check. 

NOTE: Type directly into the required fields on the Overpayment Refund Form, then print. Illegible forms may cause a delay in processing.

  • Ensure the following information is included:
    • Patient's Medicare ID Number
    • Date(s) of service
    • Claim number
    • Reason for refund
    • Refund amount
    • For refunds that are MSP-related, include the EOB or the payment allowed and paid by the primary insurer

Medicare Refund Helpful Tips:

  • Always complete the physician/refund portions and use the reason codes listed on the bottom of the form to identify the reason for your refund.
  • When refunding for multiple beneficiaries, please be sure to include sufficient documentation to show how much money is being refunded for each claim.
  • If you are sending multiple overpayments from a single office or practice, send one check.
  • We recommend that you refund no more than 20 Internal Claim Numbers (ICN, also called CCN) per check.
  • Send separate checks for overpayments previously requested (demand letters) from those that are being voluntarily refunded.
  • Send separate checks for beneficiaries being refunded due to Medicare Secondary Payer (MSP) from those being refunded due to Non-MSP.
  • When refunding due to MSP, please be sure to include the primary insurance's explanation of benefits. This is needed in order to determine the correct primary insurance allowed and paid amounts.
  • When sending a check to cover a large number of adjustments, CGS recommends sending the required information on a CD in Microsoft Excel. The CD and check can be mailed to one of lockboxes listed below:
  • If you are unable to send the information via a CD, it can be sent in an encrypted email to CHECK.DOCUMENTATION@cgsadmin.COM.
  • Mail your check along with the required documentation associated with the refund. Please remember to utilize the helpful hints section above. If your request is for MSP, please address to MSP Overpayment Recovery:
  • Make the check payable to "CGS Administrators, LLC." and mail to the appropriate address:

    CGS – J15 Part B Kentucky
    PO Box 957065
    St. Louis, MO 63195-7065

    CGS – J15 Part B Ohio
    PO Box 957352
    St. Louis, MO 63195-7352

Please allow CGS 60 days from the date of receipt to process voluntary refunds. If development is needed for coordination of benefits, please allow up to 120 days for processing.

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