Responding to a Medicare Demand Letter

Some groups may receive a letter in the mail that looks something like this. This is a Medicare Demand Letter.

It means that Medicare mistakenly paid on a claim for an employee that should have been paid by Quartz. They are asking to be paid back. Typically, Medicare will send the letter to the group with a copy to Quartz, so we have the same information in our files.  

What does a group need to do if they receive a Medicare Demand Letter?

Groups should contact Quartz right away to see if we have received our copy and to confirm we will respond to Medicare. There have been some instances when an employer received a letter, but we did not. By notifying us, they can feel confident we will resolve the situation. Groups do not need to contact Medicare directly – we will interact with them on their behalf.

What happens next?

• Our Medicare Demand Specialist may reach out to the employer with a request for information, based on the situation and how we need to respond to the demand letter.
• Quartz will send the group a letter about our response to the Commercial Repayment
  Center.

How long does the process take?

Quartz has 60 days from the date of the Medicare Demand Letter to investigate the claim and respond.

• If we determine payment to Medicare is owed, we’ll submit payment and the matter will be closed.
• If we don’t think reimbursement is due, there is a process for us to go back and forth with Medicare before a final determination is made. The group will be notified of the outcome via a letter from the Centers for Medicare & Medicaid Services (CMS).