Overpayments
An overpayment can be identified by the provider or IntegraNet Cost Containment Unit (CCU). If the provider identifies the overpayment, they can either submit a refund check all with an explanation of refund and/or Explanation of Payment (EOP) to IntegraNet or they can call Claims at (832) 320-7220 and approve a recoupment from any future payments to the provider. If IntegraNet identifies the overpayment, a recovery letter will be sent to the provider, the provider has 45 days to submit a refund check or appeal the refund request. If the provider doesn't respond within 45 days from the date of the recovery letter, then recoupment will begin on any future payments. Refund checks along with explanation of refund can be sent to:
IntegraNet Claims Department
2900 North Loop West, Ste 700
Houston, TX 77092

IntegraNet uses an automated claims auditing system to ensure claims are adjudicated in accordance with industry billing and reimbursement standards. Claims auditing software ensures compliance with an ever-widening array of edits and rules as well as consistency of payment for providers by ensuring correct coding and billing practices are being followed. Using a sophisticated auditing logic, our code editing system determines the appropriate relationship between thousands of medical, surgical, radiology, laboratory, pathology and anesthesia codes and processes those services according to the NCCI. NCCI was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment. NCCI code pair edits are automated prepayment edits that prevent improper payment when certain codes are submitted together for Part B-covered services.

In addition to code pair edits, the NCCI includes a set of edits known as Medically Unlikely Edits (MUEs). An MUE is a maximum number of Units of Service (UOS) allowable under most circumstances for a single HCPCS/CPT code billed by a provider on a date of service for a single beneficiary.