Bill > S770

This bill aims to prevent insurance carriers from inappropriately denying or recouping payments for medically necessary health care services by establishing several key protections for healthcare providers and patients. The bill requires carriers to pay for health care services ordered by a treating provider if the services are a covered benefit and follow the carrier's clinical review criteria. Carriers are prohibited from denying claims due to minor administrative or technical defects, and can only recoup payments within 12 months of the original payment, with additional restrictions on retroactive terminations. The bill mandates that carriers provide detailed written notice before seeking to recoup payments, giving providers 30 days to challenge the request. If a claim is denied due to an unintentional error in authorization, the carrier must conduct a retrospective review within 30 days and reverse the denial if the service is determined to be medically necessary. The bill also requires the insurance commissioner to develop implementing regulations within 90 days, which will apply to new, renewed, or amended provider contracts. These provisions are designed to protect healthcare providers from arbitrary claim denials and ensure patients receive necessary medical services.

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https://malegislature.gov/Bills/194/S770