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 specified 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 considered final. Additionally, the bill prohibits third-party payers from changing their payment, audit, or review timelines during the contract period.

The bill also modifies the process for third-party payers to recover overpayments. It stipulates that recovery must be initiated within the timeframe established in the new provision, rather than the previous two-year limit. The third-party payer is required to notify the provider of the overpayment determination in writing, providing specific details about the overpayment and the appeal process. Furthermore, if the provider does not respond within thirty days or chooses not to appeal, the payer can recover the overpayment through deductions from future payments or other remedies. Any contractual provisions that contradict these new regulations will be deemed unenforceable.

Statutes affected:
As Introduced: 3901.388