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Bill > HF637
IA HF637
IA HF637A bill for an act relating to the recovery of overpayment of a claim by a dental carrier.(Formerly HSB 190.)
summary
Introduced
02/28/2025
02/28/2025
In Committee
04/03/2025
04/03/2025
Crossed Over
Passed
Dead
Introduced Session
91st General Assembly
Bill Summary
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 90 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 28 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.
AI Summary
This bill establishes new regulations for dental carriers (insurance companies) regarding the recovery of overpayments made to dental care providers. The bill defines an overpayment as a payment made in error by a dental carrier to a dental provider for a dental care service. It requires dental carriers to create written policies that allow providers to appeal overpayment recovery requests within at least 90 calendar days and provide access to claim information related to the dispute. Dental carriers must provide written notice of an overpayment to the provider within 365 calendar days of the original payment, specifically identifying the error in processing or payment. If a carrier wants to recover an overpayment by withholding or reducing payment on a different claim, they must provide written notice within 28 calendar days, detailing the original overpaid claim and the amount being recovered. The bill includes an exception for overpayment recovery efforts based on reasonable belief of fraud or intentional misconduct. Importantly, the bill stipulates that these requirements cannot be waived by contract, and any contract attempting to do so would be considered null and void. The commissioner of insurance is authorized to adopt rules to implement these provisions.
Committee Categories
Business and Industry
Sponsors (0)
No sponsors listed
Other Sponsors (1)
Commerce (House)
Last Action
Referred to Commerce. H.J. 895. (on 04/03/2025)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.legis.iowa.gov/legislation/BillBook?ga=91&ba=HF637 |
| BillText | https://www.legis.iowa.gov/docs/publications/LGI/91/attachments/HF637.html |
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