This bill aims to limit the ability of healthcare insurers to recoup payments for healthcare services beyond a one-year period after the initial payment was made. It introduces a new subchapter to the Arkansas Code, specifically addressing recoupment practices. Under the proposed law, healthcare insurers can only exercise recoupment within 365 days of payment, except in cases of fraud. Insurers are required to provide written or electronic statements to healthcare providers detailing the basis for any recoupment actions, including the specific reasons and relevant information about the claims involved.
Additionally, the bill outlines the definitions of key terms such as "covered person," "health benefit plan," and "recoupment," and establishes the conditions under which recoupment may not be exercised, particularly when a healthcare provider has verified a patient's coverage in good faith. It mandates that insurers must notify providers of any verification errors within 90 days of payment and provides guidelines for documentation and disclosure requirements related to recoupment actions. Non-compliance with these regulations would subject insurers to penalties under the Trade Practices Act.