Bill > S582

This bill aims to limit retroactive denials of health insurance claims for mental health and substance abuse services. It establishes restrictions on when insurance providers, including the Group Insurance Commission and MassHealth, can deny previously paid claims. The bill defines "retroactive claim denial" and outlines specific conditions under which such denials may be permitted, such as when a claim was submitted fraudulently or is subject to payment from another payer. The bill also requires insurance providers to notify providers before imposing a retroactive claim denial and gives providers time to determine if the claim is subject to payment by a secondary insurer. Additionally, the bill directs the Division of Medical Assistance to develop an internal process for reconciling claims due to retroactive eligibility changes or duplicate enrollments in MassHealth cases involving multiple payers.

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https://malegislature.gov/Bills/190/S582