Introduced Version






HOUSE BILL No. 1760

_____


DIGEST OF INTRODUCED BILL



Citations Affected: IC 27-8-5.7-10; IC 27-13-36.2-8.

Synopsis: Overpayments to health care providers. Specifies certain requirements for an insurer or a health maintenance organization in requesting repayment or adjusting subsequent claims to obtain reimbursement for an overpaid claim to a health care provider.

Effective: July 1, 2005.





Pelath




    January 19, 2005, read first time and referred to Committee on Insurance.







Introduced

First Regular Session 114th General Assembly (2005)


PRINTING CODE. Amendments: Whenever an existing statute (or a section of the Indiana Constitution) is being amended, the text of the existing provision will appear in this style type, additions will appear in this style type, and deletions will appear in this style type.
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HOUSE BILL No. 1760



    A BILL FOR AN ACT to amend the Indiana Code concerning insurance.

Be it enacted by the General Assembly of the State of Indiana:

SOURCE: IC 27-8-5.7-10; (05)IN1760.1.1. -->     SECTION 1. IC 27-8-5.7-10 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 10. (a) An insurer may not, more than two (2) years after the date on which an overpayment on a provider claim was made to the provider by the insurer:
        (1) request that the provider repay the overpayment; or
        (2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.
    (b) Every adjusted subsequent claim described in subsection (a)(2) must be accompanied by an explanation of the reason for the adjustment, including:
        (1) an identification of the:
            (A) claim on which the overpayment was made; and
            (B) party financially responsible for the overpaid amount; and
        (2) the amount of the overpayment that is being reimbursed

to the insurer through the adjusted subsequent claim.
    (c) This section does not apply if the provider or insured has been charged with or convicted of fraud with respect to the claim on which the overpayment was made.

SOURCE: IC 27-13-36.2-8; (05)IN1760.1.2. -->     SECTION 2. IC 27-13-36.2-8 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2005]: Sec. 8. (a) A health maintenance organization may not, more than two (2) years after the date on which an overpayment on a provider claim was made to the provider by the health maintenance organization:
        (1) request that the provider repay the overpayment; or
        (2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.
    (b) Every adjusted subsequent claim described in subsection (a)(2) must be accompanied by an explanation of the reason for the adjustment, including:
        (1) an identification of the:
            (A) claim on which the overpayment was made; and
            (B) party financially responsible for the amount overpaid; and
        (2) the amount of the overpayment that is being reimbursed to the health maintenance organization through the adjusted subsequent claim.
    (c) This section does not apply if the provider or enrollee has been charged with or convicted of fraud with respect to the claim on which the overpayment was made.