NHS DME JA Overpayment Refund Form This is a fillable Overpayment Refund form 2025

1. Click ‘Get Form’ to open the NHS DME JA Overpayment Refund Form in the editor.
2. Begin by entering your Provider/Physician/Supplier name, address, and contact information in the designated fields. Ensure accuracy for smooth processing.
3. Fill in the PTAN, NPI, and Tax ID numbers as required. These identifiers are crucial for tracking your refund request.
4. In the Refund Information section, provide patient details including their name, HIC number, date of service, and Medicare claim number.
5. Select a reason for the refund from the provided list. Only one reason code should be used per claim to avoid confusion.
6. If applicable, indicate whether Medicare is secondary by selecting 'Yes' or 'No'. Attach any necessary documentation if Medicare is secondary.
7. Review all entered information for accuracy before submitting. Once complete, forward the form to your Medicare contractor as instructed at the bottom of the form.

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