Bill > H4315

This bill limits retroactive denials of health insurance claims for behavioral health and substance abuse services. Key provisions include: - Prohibiting health insurers, the state's Group Insurance Commission, and the state Medicaid program from imposing retroactive claim denials for behavioral health services unless certain conditions are met, such as the claim being submitted fraudulently or subject to expected payment from another payer. - Requiring insurers to provide providers with a written explanation for any retroactive claim denial and allow them 12 months to resolve issues. - Defining "behavioral health" and "retroactive claim denial" to provide clarity on the terms used in the bill. - Directing the state Medicaid program to develop an internal process to reconcile claims due to retroactive eligibility changes or duplicate enrollments without requiring provider involvement. The overall aim of the bill is to limit the practice of insurers retroactively denying previously paid claims for behavioral health and substance abuse services, which can create financial hardship for providers.

Budget and Finance, Health and Social Services

https://malegislature.gov/Bills/190/H4315