• A
  • |
  • A
  • Text size

Overpayment Recovery and Claims Appeals

Ensuring proper processing and payment of health care claims is vital to the financial health of a physician practice. However, addressing claims payment issues can be complicated, challenging and administratively burdensome for practices. Whether a physician’s office is navigating the overpayment recovery process or appealing a perceived underpayment, the AMA offers resources to help physicians secure correct claims payment from health plans.

Sample appeal letters

View sample claims management letters for the physician practice. As a benefit of membership, AMA members can download these sample letters as Word files to modify and customize in their practices.

AMA members can also access the National Managed Care Contract Database, where they can look up state laws and regulations to copy and paste into their appeal letters.

Authorization & eligibility

Contractual obligation

Medical necessity

Payer-applied edits

Prompt Payment

General 

Overpayment Recovery Toolkit

Attempting to determine the validity of alleged overpayments can divert significant time from direct patient care, which results in lost practice revenue. Overpayment demands may be made in very general terms and may also be intimidating. However, it is critical for physician practices to effectively and efficiently address overpayment recovery requests.

In order to help physicians understand and address health insurer overpayment recovery requests, the AMA has created the Overpayment Recovery Toolkit.

Access this resource

LinkedIn Discussion Group
Join discussions in the AMA Administrative Simplification LinkedIn Group.