Examples of Overpayment Claims Processes

Below are some possible claim examples processes:

Example 1. GA case with an AE overpayment balance of $200.00, closes on 04/30. The month the case closed was the twelfth month of benefit recoupment. Since this is an AE overpayment and the period of recoupment has reached the twelfth month, no further recoupment or repayment is required, even if the claim balance is over $125.00. The claim must be canceled.

Example 2. GA case with an AE overpayment balance of $95.00, closes on 05/31. When the case closed, benefits have been reduced for 10 months. Since the claim balance is less than $125.00 no further recoupment or repayment is required after the case is closed, even if there are still two months before reaching the 12th month period. The claim must be canceled.

Example 3. GA case closes on 06/30/17 with several overpayment claims.

  • Claim 1 = AE OP with a balance of $30 - established on 09/09/16
  • Claim 2 = AE OP with a balance of $40 - established on 12/24/16
  • Claim 3 = CE OP with a balance of $15 - established on 01/10/17
  • Claim 4 = CE OP with a balance of $20 - established on 03/23/17

Total claim balance is $105

Since the sum of all claims is less than $125, all claims are to be canceled, even if none of the claims is older than 12 months. 

Example 4: GA case closes on 07/31/17 with several overpayment claims established the prior year.

  • Claim 1 = AE OP with a balance of $105 - established on 10/25/16
  • Claim 2 = AE OP with a balance of $110 - established on 11/10/16
  • Claim 3 = CE OP with a balance of $107 - established on 12/23/16

Although the balance for each claim is less than $125, the sum of all claims equals $322.00. Claims must remain open after the GA program closes for the Public Assistance Collections unit to pursue recoupment efforts.

Example 5: GA case closes on 03/31/17 with several overpayment claims.

  • Claim 1 = AE OP with a balance of $140 - established on 12/25/15
  • Claim 2 = AE OP with a balance of $70 - established on 01/10/17
  • Claim 3 = CE OP with a balance of $10 - established on 02/23/17

The sum of all claims equals $220. However, claim 1 is an AE over 12 months which must be canceled, even if the balance is more than $125. Since the sum of all other claims is less than $125, all claims must be canceled.

Related Topics

Determination of Overpayment Type