Bill > H2193

This bill aims to limit retroactive denials of health insurance claims for mental health and substance abuse services. The key provisions are: 1. It prohibits insurers, the Group Insurance Commission, and the Division of Medical Assistance from imposing retroactive claim denials on providers unless less than six months have elapsed since the claim was submitted or the insurer provides a written explanation and opportunity for the provider to address the issue. Retroactive denials are allowed after six months in limited cases of fraud, expected payment from another payer, or legal action. 2. It requires insurers to notify providers at least 15 days before imposing a retroactive denial due to expected payment from another payer, and gives providers six months to determine if the claim is subject to payment by a secondary insurer. 3. It directs the Division of Medical Assistance to develop a process for reconciling claims involving multiple payers for MassHealth enrollees, to reduce the burden on providers.

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https://malegislature.gov/Bills/190/H2193