House Bill No. by Representative Egan amends the state medical assistance program's regulations regarding provider claim payments. The bill introduces a definition for "extrapolation," which is described as a mathematical process used by managed care organizations to estimate audit results for claims not reviewed. It explicitly prohibits managed care organizations from using extrapolation in their audits of healthcare providers, stating that any payments or recoupments must be based on actual overpayments or underpayments rather than extrapolated estimates.

Additionally, the bill clarifies that the provisions cannot be waived by contract, rendering any conflicting contractual clauses void. It also establishes penalties for managed care organizations that violate these provisions, allowing for penalties to be imposed without prior notice of corrective action. The bill aims to enhance the protection of healthcare providers in the claims payment process and ensure fair practices in audits conducted by managed care organizations.

Statutes affected:
HB786 Original: