Patient refund requests

How do we handle a patient credit balance or overpayment, capture the refund details, approve it and write the refund to billing within the rules for returning overpayments?

Treat every credit balance as a refund case with a clock. When a credit balance or an overpayment is found on an account (a payment above the final patient share, a duplicate payment, a deposit against an estimate that came in lower, a payer adjustment), Callvu prefills the account, the payments and the adjudication, classifies the credit (a patient refund, a payer refund, a transfer to another open balance where the policy and the law allow, a credit that is a posting error), determines the right payee and captures the refund details and the method from the patient on a secure screen, routes the refund to the patient accounts approver in the Decision Desk by amount tier, and writes the approved refund to the billing system with the payment issued and the account cleared within the policy's period.

In scopeSimpleCallvu moves: prefill, decide, write back

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Last updated November 7, 2026.

The problem today

The patient's credit balance from a deposit sat for fourteen months; the state's unclaimed property auditor found it before the patient did.

Today, without Callvu

Credit balances accumulate quietly: a deposit that exceeded the final share, a copay collected and then waived by the claim, a payment posted twice, a payer that overpaid. Refunding them is nobody's priority; the credit sits until a patient calls, an auditor arrives, or the state's unclaimed property deadline passes. For government payers, an identified overpayment held past the deadline is a false claim.

The rules are concrete: a Medicare or Medicaid overpayment must be reported and returned within 60 days of being identified; a patient credit balance becomes unclaimed property after the state's dormancy period and must be reported and remitted; the hospital's policy sets the refund approval tiers and the period. Finding the credit, deciding who it belongs to, verifying the payee and approving the amount are steps a process can run on the day the credit appears.

A refund issued in days is a patient who trusts the next bill.

How it runs

From the requestto the system of record.

A credit balance or an overpayment is identified on an account (by the billing system's credit report, a patient's request or a payer notice). Callvu opens the refund case.

Patient or guarantor: Confirms the refund and the method on a secure screen, or asks for the refund.
Patient accounts: Approves refunds by tier in the Decision Desk.
Payer: Receives a payer refund or a recoupment under its rules.
Callvu: Prefills, classifies, determines the payee, captures the details, routes, issues and writes.

Prefill and classify
The account, the encounters, the payments by source and date, the claims' adjudication and the final patient share are prefilled from the billing system; the credit is classified: a patient overpayment, a duplicate payment, a deposit above the final share, a payer overpayment, a credit from a posting error (corrected rather than refunded), or a credit that may be applied to another open balance of the same guarantor where the policy and the law allow.
Determine the payee and capture the details
The payee is determined from who paid (the patient, the guarantor, a card that must be refunded to itself, a payer), and the patient confirms the refund and the method on a secure screen (the original card, a bank account with verification, a check to the address on file) with the amount and what it relates to; a payer overpayment follows the payer's refund or recoupment process with the clock the rules set.
Decide
The refund goes to the patient accounts approver in the Decision Desk by amount tier with the account history and the classification, and only the allowed outcomes: approve, approve a different amount with the reason (a balance on another encounter where the policy allows the application and the patient agrees), hold for a pending claim adjustment, or deny with the explanation.
Write back
The approved refund is written to the billing system, the payment is issued through the payables process to the payee by the method chosen, the account is cleared, the patient receives the confirmation, and an uncashed or undeliverable refund is tracked toward the state's unclaimed property reporting on its dormancy clock.

Where it ends: The credit was classified on the day it appeared, refunded to the right payee by the method they chose, approved by the tier's owner, and the billing system holds the refund with the account cleared inside the rules' periods. The Decision Trace shows the classification, the payee and the decision; the Audit Trace shows the capture, the approval and the payment with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

Medicare and Medicaid overpayment reporting and return (42 USC 1320a-7k(d) and 42 CFR 401.305): A provider that has identified an overpayment from Medicare or Medicaid must report and return it within 60 days of identification (or the cost report due date where later); an overpayment retained past the deadline is an obligation under the False Claims Act, so payer credits are classified and clocked from the date identified.
State unclaimed property acts (the Revised Uniform Unclaimed Property Act as adopted): A patient credit balance or an uncashed refund becomes presumptively abandoned after the state's dormancy period (commonly three years), after which the hospital must send due diligence notices and report and remit the property to the state; a refund issued promptly avoids the obligation, and an undeliverable one is tracked to it.
Card network refund rules, PCI DSS and the hospital's refund approval policy: A card payment is refunded to the original card under the network rules where possible, a bank refund needs account verification, the refund details are captured on a secure screen, and the policy sets the approval tiers, the segregation between approval and payment and the period for issuing refunds.

Company policies

Every credit balance opens a refund case on the day it is identified; none waits for a call.
The payee is who paid; a card is refunded to itself; a transfer to another balance needs the policy's and the patient's agreement.
Approval is by amount tier in the Decision Desk, separate from payment.
The billing system is the system of record for the credit, the refund and the clearance.

Controls

Credit identification and prefill.
Classification by credit type and payer.
Payee determination and secure detail capture.
Decision Desk approval by tier.
Payables issue and billing system write.
Overpayment and unclaimed property clocks.

Clocks and deadlines

Government payer overpayment: Reported and returned within 60 days of identification.
Patient refund: The policy's period from identification (commonly 30 days).
Unclaimed property: An uncashed or undeliverable refund tracked to the state's dormancy period and reporting date.

Documents and checks

The account, the payments and the adjudication
The classification and the payee
The refund details as captured
The approval
The payment and the billing system record

In the Decision Trace

The classification and the payee.
The decision, its tier and the person.

In the Audit Trace

The identification with time.
The capture and the approval with time.
The payment and the clearance.

The handoff

Between the front doorand the back office.

The front door

The patient on a secure screen from a text or the portal, or the patient's own request in any channel.

The back office

Patient accounts approves by tier; payables issues; nobody works a credit report by hand.

The Decision Desk

Every refund goes to the patient accounts approver in the Decision Desk by amount tier, with the account history and the classification, and only approve, approve a different amount with reason, hold for a pending adjustment, or deny with explanation.

Proof

In scope.Proof at scale, not one process at a time.

The kind of process Callvu runs in production for customers in this industry. Ask for a reference on this exact process. The results below are the industry's published proof; each claim code links to its record on agents.callvu.com.

23 hospitals in the Ministry of Health network run on Callvu.

Across Callvu customers

More than 1,000 processes are live across Callvu customers.

Across Callvu customers

Questions

What buyers ask next,answered plainly.

When is a refund issued?

Within the policy's period from the day the credit is identified; a government payer overpayment is returned within 60 days of identification as the rules require.

Who receives it?

Whoever paid: the patient or guarantor by the method they confirm on a secure screen, a card refunded to itself, or the payer under its refund or recoupment process.

Can the credit be applied to another bill?

Only where the policy and the law allow and the patient agrees on the screen; otherwise it is refunded.

Related processes

Pre-service deposit and copay collection Charge correction requests Billing disputes Patient payment plans Try it in the sandbox All healthcare processes

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