Relevant Statute
Insurance Code 420-J;8-b.
Time Period
18 Months
Limits for Recovery on Overpaid Claims
No health carrier shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless: (a) the carrier has denial in writing to the health care provided the reason for the retroactive provider; and (b) the time which has elapsed since the date of payment of the challenged claim does not exceed 18 months.
Additional Details
None
Exemptions
Time limit can be extended belong the period of 18 months provided claim was submitted fraudulently or claim was incorrect because the provider was already paid for the services claim payment is the subject of adjustment with a different insurer.
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