The bill amends section 3901.388 of the Revised Code to modify the timeframe for health insurers to recoup payments from healthcare providers. Specifically, it reduces the period during which a payment is considered final from two years to one year after the payment is made. Additionally, it stipulates that no third-party payer can change its payment, audit, or review timelines during the contract period. The bill also requires that any recovery of overpayments must be initiated within one year of the payment, and it mandates that providers be given an opportunity to appeal the determination of overpayment without incurring any fees.

Furthermore, the bill outlines the requirements for the notice of overpayment that third-party payers must provide to providers, including specific details such as the beneficiary's name, service dates, and the amount of overpayment. It also specifies that if a provider fails to respond to the notice within sixty days, the payer may recover the overpayment through deductions from future payments owed to the provider. The bill ensures that any contractual provisions contrary to these new regulations are unenforceable, thereby reinforcing the changes made to the recoupment process.

Statutes affected:
As Introduced: 3901.388
As Reported By Senate Committee: 3901.388
As Passed By Senate: 3901.388