Bill > S2216

This bill seeks to limit the ability of insurers, including the Group Insurance Commission, the state's Medicaid program (MassHealth), and other entities that manage behavioral health services, to retroactively deny previously paid claims for behavioral health services. The bill establishes a general prohibition on retroactive claim denials, except in certain limited circumstances such as when a claim was submitted fraudulently or is subject to adjustment due to expected payment from another payer. The bill also requires insurers to provide written explanations to providers before imposing retroactive denials and allows providers time to determine if a claim may be payable 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, without requiring provider involvement.

https://malegislature.gov/Bills/190/S2216