Bill > HB1450

This bill requires health insurance carriers, which include insurers, nonprofit health service plans, health maintenance organizations, dental plan organizations, and managed care organizations, to actively identify primary and secondary payers for claims and determine the amounts each payer is responsible for when a claim is subject to coordination of benefits. Coordination of benefits is a process used when a patient has coverage from more than one insurance plan to determine which plan pays first and how much each plan will pay, ensuring that the combined payments do not exceed the total cost of the service. The bill also alters the timeframe during which a carrier can retroactively deny reimbursement, meaning a carrier cannot take back money already paid to a healthcare provider. Specifically, for services subject to coordination of benefits with another carrier, a carrier can only retroactively deny reimbursement within 9 months of payment. This period extends to 18 months if the coordination of benefits involves the Maryland Medical Assistance Program or the Medicare Program. For other situations, the denial period remains 6 months, unless the denial is due to fraud, improper coding (with specific notice requirements), duplicate claims, or specific circumstances related to Medicare recipients in managed care organizations. If a carrier retroactively denies reimbursement due to coordination of benefits, the healthcare provider then has 6 months to resubmit the claim to the responsible payer.