Bill > HB05377

This bill aims to improve the process for health care providers dealing with insurance companies by shortening the time frame in which health carriers, or insurance companies, can dispute or reclaim payments for services rendered. Specifically, it reduces the period from eighteen months to fifteen months after a clean claim, which is a properly submitted and complete request for payment, is received, before a health carrier can cancel, deny, or demand the return of payment, except in cases of suspected fraud, incorrect billing, duplicate payments, or when another payer should have covered the cost. The bill also mandates that health carriers establish an electronic appeal process for providers to contest these decisions and requires that if an appeal is not decided within twelve business days, it will be ruled in favor of the provider. Additionally, the bill requires hospital-based facilities, which are healthcare locations associated with a hospital but not physically on its main campus, to include their specific National Provider Identifier (NPI), a unique identification number for healthcare providers, and their federal tax identification number on all claims for reimbursement. This ensures that payments are correctly attributed to the specific off-site facility and not just the main hospital campus, and it prevents these facilities from billing patients if they fail to submit claims correctly to the insurance carrier.

Business and Industry

Insurance and Real Estate Committee (Joint)

https://www.cga.ct.gov/asp/cgabillstatus/cgabillstatus.asp?selBillType=Bill&bill_num=HB05377&which_year=2026