The bill addresses regulations concerning contracts between insurers and dental healthcare providers, specifically focusing on the timelines for reviews, audits, and investigations of claims. It mandates that any review or investigation resulting in the recoupment of funds must be completed within six months of the claims being paid. However, exceptions are made for cases involving fraud, inappropriate billing patterns, coordination of benefits, or claims subject to federal regulations that allow for longer review periods. Additionally, the bill prohibits dental benefit plans or utilization review entities from denying claims for procedures that have received prior authorization, unless specific conditions are met, such as changes in the patient's condition or documentation issues.

Furthermore, the bill amends K.S.A. 40-2,185 by removing provisions that previously restricted contracts between health insurers and dentists regarding fees for services. It ensures that contracts cannot limit fees for non-covered services and cannot include clauses that allow insurers to deny payment for covered services while also preventing dentists from billing patients for necessary services. The existing section of K.S.A. 40-2,185 is repealed, and the new regulations will take effect upon publication in the statute book.

Statutes affected:
As introduced: 40-2