Bill > HB2556

This bill aims to improve the contract terms between health insurers and dentists and streamline the claims review process. It mandates that any review, audit, or investigation by a nonprofit dental service corporation concerning claims that lead to the recoupment or withholding of previously paid funds must be completed within six months of the initial payment, with exceptions for fraudulent claims, patterns of inappropriate billing, coordination of benefits, or claims subject to federal laws allowing longer review periods. Additionally, the bill prohibits dental benefit plans or utilization review entities from denying a claim for a procedure that received prior authorization, which is defined as written confirmation from the plan that a specific procedure is covered and reimbursable, unless certain conditions are met, such as reaching benefit limitations, insufficient documentation, changes in the patient's condition, or the provision of new procedures. The bill also amends existing law to prevent contracts between insurers and dentists from limiting the fee a dentist can charge for non-covered services or from disallowing a service that would have been covered while also preventing the dentist from billing the patient for that service if it was medically necessary, with "dental necessity" being defined as a service a prudent dentist would provide to diagnose, prevent, or treat oral health issues. Finally, the bill repeals the existing statute that it amends.

Business and Industry

Health and Human Services (House)

https://kslegislature.gov/li/b2025_26/measures/hb2556/