Bill > SF3214

This bill modifies the existing law regarding healthcare provider reimbursement by reducing the deadline for adjustments and recoupments of clean claims from 12 months to six months, with an exception for coordination of benefits claims which retain a 12-month deadline. The bill prohibits health plan companies and third-party administrators from adjusting or recouping payments after these specified deadlines, with exemptions for pharmacy contracts and fraud-related cases. Additionally, the bill introduces new requirements for health plan companies and third-party administrators when adjusting or recouping payments related to coordination of benefits: they must provide a written statement to the healthcare provider that specifies the basis for the adjustment or recoupment and includes the name and address of the entity responsible for the claim. Furthermore, the bill gives healthcare providers 180 days after an adjustment or recoupment to submit a claim for reimbursement to the responsible health plan company, unless a longer time period is permitted. These changes aim to create more transparency and establish clearer timelines for healthcare payment processes.

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https://www.revisor.mn.gov/bills/bill.php?b=Senate&f=SF3214&ssn=0&y=2025