Limits health carriers' ability to recoup, recover, or retroactively deny previously paid claims.

This bill restricts health carriers' ability to recoup, recover, or retroactively deny previously paid claims. It mandates that health carriers notify providers in writing at least thirty days before denying a claim retroactively. If the carrier fails to respond to the provider's determination within the required time, the matter is resolved. Providers have six months to refund the claim payment unless an exception applies. If disputes persist, either party can request a mandatory review from the Division of Insurance.

Limits health carriers' ability to recoup, recover, or retroactively deny previously paid claims.

This bill restricts health carriers' ability to recoup, recover, or retroactively deny previously paid claims. It mandates that health carriers notify providers in writing at least thirty days before denying a claim retroactively. If the carrier fails to respond to the provider's determination within the required time, the matter is resolved. Providers have six months to refund the claim payment unless an exception applies. If disputes persist, either party can request a mandatory review from the Division of Insurance.