Relevant Statute
M. A. Code section 15-1008
Time Period
6 Months
Limits for Recovery on Overpaid Claims
A carrier may only retroactively deny reimbursement paid to healthcare provider during the six month period after the date the carrier paid the claim.
Additional Details
18 Months when COB is involved
Exemptions
No limit for 1. Fraud, 2. Improperly coded, 3. Duplicate Payment, 4. a claim submitted to MCO & the claim was for services provided to a MD Medical Assistance Program recipient during a time period when Program has permanently retracted the capitation payment for the Program recipient.
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