Bill > SB162

This bill amends Ohio state law regarding how health insurers (third-party payers) can recoup overpayments from healthcare providers. The key changes include establishing that a payment becomes final upon the conclusion of a time period equal to the number of days the health plan issuer allows for filing provider claims, and explicitly prohibiting health insurers from changing their payment, audit, or review timelines during a contract period. The bill requires insurers to initiate any overpayment recovery within this specified timeframe and provides detailed requirements for how insurers must notify providers about potential overpayments, including providing a written notice with specific information such as the patient's name, service dates, overpayment amount, and a detailed explanation of the overpayment determination. The bill also mandates that insurers give providers an opportunity to appeal overpayment determinations without charging a fee, and allows providers to repay overpayments through direct payments or deductions from future payments. Importantly, any contractual provisions that conflict with these requirements would be considered unenforceable, providing additional protection for healthcare providers against potentially arbitrary recoupment practices.

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https://www.legislature.ohio.gov/legislation/136/sb162