The bill amends section 3901.388 of the Revised Code to establish a new timeframe for health insurers to recoup payments from healthcare providers. Under the revised law, a payment made by a third-party payer will be considered final upon the conclusion of a time period that begins on the date the payment is made and ends after the same number of days that the health plan issuer allows for filing provider claims. This replaces the previous two-year period after which payments were deemed final. Additionally, the bill prohibits third-party payers from changing their payment, audit, or review timelines during the contract period.

Furthermore, the bill stipulates that a third-party payer may recover overpayments only within the timeframe established in the new provision. It requires that providers be notified in writing of any overpayment determinations, including specific details such as the beneficiary's name, service dates, and the amount of overpayment. The bill also ensures that providers have the opportunity to appeal overpayment determinations without incurring fees. Any contractual provisions that contradict these new regulations will be deemed unenforceable. The existing section 3901.388 is repealed to implement these changes.

Statutes affected:
As Introduced: 3901.388