This bill aims to limit the ability of health carriers to recoup, recover, or retroactively deny previously paid claims. It establishes that a health carrier may only retroactively deny a claim within eighteen months from the date of payment, provided they give written notice to the provider. However, this does not apply to claims that were submitted fraudulently, are subject to adjustments with other payors, or involve services covered by casualty insurance, self-insured health plans under ERISA, Medicare, Medicaid, workers' compensation, or claims that were already paid. Additionally, the bill outlines that a violation of this section can be enforced by the Division of Insurance.

Furthermore, the bill mandates that health carriers must notify providers in writing at least thirty days before retroactively denying a claim. Providers have six months to refund the claim payment unless they assert an applicable exception. If disputes arise, either party can request a mandatory review from the Division of Insurance, and legal action can only commence after the division's recommendation is provided. The bill also specifies that any payment returned by the provider must match the original amount paid by the carrier without additional fees or penalties. This Act will apply to claims for healthcare services provided on or after July 1, 2026.