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 outlines the process for third-party payers to recover overpayments, which must now be initiated within the timeframe established in the new provision. It mandates that third-party payers inform providers of any overpayment determinations in writing, providing specific details about the overpayment and the appeal process. The bill also ensures that providers are not charged a fee for appealing an overpayment determination and allows for various methods of repayment. Any contractual provisions that contradict these new regulations will be deemed unenforceable.

Statutes affected:
As Introduced: 3901.388