Payment of health claims.

From the Legislature

Payment of health claims. Requires a hospital to: (1) disclose information concerning payment assistance programs; (2) post signs concerning the programs in specified locations of the hospital; and (3) make information concerning the programs available to individuals through the hospital's patient portal. Requires a hospital to make a reasonable effort to notify individuals of available payment assistance programs before beginning a collection action against the individual. Prohibits the use of downcoding in a specified manner. Prohibits a provider from using an automated process, system, or tool to submit a health benefits claim without the review of a provider or other person involved in the development of the claim for submission. Prohibits an insurer that issues a policy of accident and sickness insurance (insurer) and a health maintenance organization from retroactively reducing the reimbursement rate for any CPT code. Sets forth limitations on the time frame in which an insurer and a health maintenance organization: (1) may request repayment of an overpayment, adjust a subsequent claim, recoup a paid claim, or retroactively audit a paid claim; and (2) is required to correct a payment error to a provider. Provides that if an insurer or a health maintenance organization recoups payment from a provider due to an error in coordination of benefits, the provider may submit a claim for the same services to the appropriate insurer or health maintenance organization.