Relevant Statute
Ann. § 23-61-108, §23-63-1806, §25-15-201
Time Period
18 Months
Limits for Recovery on Overpaid Claims
A health care insurer cannot seek refund of paid claim after the expiration of eighteen (18) months from the date the claim was initially paid.
Additional Details
A health care insurer has one hundred and twenty (120) days from the date of payment to notify the provider of a verification error and the fact that services rendered will not be covered if the error was made in good faith at the time of the verification.
Exemptions
Except in cases of fraud committed by the health care provider, means fraud that the insurer discovered after the eighteen (18) month period and could not have discovered prior to the end of the eighteen-month period.
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