Third Party Administrator
Hometown Health Providers also provides TPA services and furnishes a contracted network and other health-insurance services to self-funded employer groups .
When a patient has benefit coverage with a self-funded group , a TPA may have responsibility for eligibility , utilization review and claims payment .
Please refer to the member ’ s identification card to determine the services that are provided by Hometown Health . This information may also be located on Link or by contacting Hometown Health Customer Service at 775-982-3232 or 800-336-0123 .
Overpayments
“ Overpayments ” are funds that PROVIDER / HOSPITAL has received that exceed the amount due and payable under the member ’ s benefit plan and / or terms of the provider contract . In the event Hometown Health identifies an Overpayment to PROVIDER / HOSPITAL , Hometown Health will apply the Overpayment against future claim payments in accordance with the PROVIDER / HOSPITAL Agreement and applicable law , whichever is more stringent .
If you refund an overpayment please provide appropriate documentation that outlines the overpayment , including the member name , member ID number , date of service , and the amount paid . Please also include a copy of the EOP . If the refund is due as a result of coordination of benefits with another carrier , please provide a copy of the other carrier ’ s EOB with the refund .
If you disagree with a claim reconsideration or re-adjudication , you can appeal the determination through our provider reconsideration process .
Notification of Claims Determination
A claim determination will result in the issuance of an EOP , or 835 electronic file if payment is submitted through Electronic Funds Transfer ( EFT ), by Hometown Health . It is important to notify your Provider Services Representative of any address changes to ensure any claims determination information is received in a timely manner .
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