Set Up an Extended Repayment Schedule

Forms you’ll need

If repaying an overpayment would constitute a “hardship” on the provider, a request for an ERS should be submitted immediately.

While you may request an ERS at any time during the debt-collection process, timely submission of a valid request may decrease the necessity to withhold interim payments. Please refer to your demand letter for information on when the overpayment is eligible for offset.

To request an extended repayment schedule, complete the Applying for an Extended Repayment Schedule form and email the form and all required documents to the J6 ERS shared mailbox at j6A.ers.requests@anthem.com or the JK ERS shared mailbox at jkextendedrepaymentschedules@anthem.com.

A valid initial request must include a signed ERS request that references the overpayment amount/letter, a signed proposed amortization schedule that includes the term of the ERS requested and a good faith payment based on the proposed amortization schedule. Once a valid request is received, withholding on the overpayment will be suspended during the review process. All other required documents must be submitted within 16 days from the initial request.
Any payments withheld will be applied to the outstanding overpayment and will not be refunded.
Any approved ERS will run from the ERS approval date.
You must continue to submit monthly good faith payments until written approval or denial is received. If you fail to continue to submit monthly payments, we may initiate withhold of interim payments up to 100%.
Your check should be made payable to National Government Services and reference “ERS (Part A or Part B) Request.”

Reviewed 10/17/2024