Part b notification form 2026

1. Click ‘Get Form’ to open the Part B Overpayment Notification form in the editor.
2. Begin by filling in your Provider/Physician/Supplier Name, Address, and Provider Number. Ensure that your NPI and Tax ID # are accurately entered.
3. Indicate the amount of the check you are submitting along with the check number and date. This information is crucial for processing your refund.
4. In the REFUND INFORMATION section, provide details for each claim including Patient Name, HIC Number, Medicare Claim Number (ICN), Date of Service, and Claim Amount Refunded. Select a reason code from the provided list for each claim.
5. If necessary, attach a separate sheet for additional claim numbers involved in the refund process.
6. Finally, sign and date the form before submitting it to ensure all information is validated and processed correctly.

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