Relating to the recovery of overpayment of a claim by a dental carrier

This bill relates to the recovery of an overpayment of a claim by a dental carrier. Under the bill, a carrier shall establish written policies and procedures for a provider to appeal an overpayment recovery or overpayment recovery request. “Overpayment” is defined in the bill. A carrier shall notify a provider of the policies and procedures to appeal the overpayment recovery or overpayment recovery request, and such policies and procedures must allow a provider to appeal such recovery or request within a minimum of calendar days after the notice is received. The policies and procedures also must allow the provider to access the claim information that is the subject of the overpayment dispute. A carrier shall not attempt to recover an overpayment made to a provider unless, no later than 365 calendar days after the date the provider receives the overpayment, the carrier provides written notice of the overpayment to the provider identifying the error made in the processing or payment, and stating a request for recovery of the overpayment or notice of withholding or reducing a payment to the provider. If such a recovery attempt is made, a carrier shall be deemed to have met the notice requirement. A carrier may attempt to recover an overpayment by withholding or reducing payment to a provider for a different claim if the carrier notifies the provider in writing within calendar days after the date of withholding or reducing the payment for the other claim. The notice must identify the original claim that was overpaid, the amount being withheld or reduced for the overpayment and recovery, and the payment from which such amount is being recovered or reduced. The requirements of the bill shall not be waived by contract. Any contract contrary to the bill shall be null and void. The commissioner of insurance may adopt rules pursuant to Code chapter 17A to administer the bill.