This bill establishes new regulations regarding prior authorization for dental care services, the notification of dental care providers about state-regulated dental care service plans, and the recovery of overpayments by dental carriers. Under the new provisions, a dental carrier is prohibited from denying claims for services that have been approved through prior authorization, and must reimburse providers at the contracted rate for those services. However, there are specific exceptions under which a claim may be denied, such as changes in the covered person's eligibility or dental condition after prior authorization has been granted.

Additionally, the bill mandates that if a covered person's dental care service plan is subject to state insurance laws, the dental carrier must inform providers that the plan is state-regulated through an online portal and include this information on identification cards issued to covered persons after July 1, 2025. The bill also outlines the procedures for dental carriers to recover overpayments, requiring them to notify providers within 365 days of the overpayment and allowing providers to appeal such recoveries within 90 days. Importantly, the requirements set forth in the bill cannot be waived by contract, ensuring that these protections remain in place.