South Dakota2026Active
HB1292
Limits on Health Carrier Claim Recoupment
Last scannedAug 25, 2026, 3:29 AM
In one sentence
This law limits health carriers to an 18-month window for taking back money from previously paid claims, with specific exceptions.
What it does
- Requires health carriers to provide written notice of the reason before recouping or retroactively denying a claim within 18 months of payment.
- Allows health carriers to take back payments at any time if the claim involved fraud, waste, or abuse.
- Excludes claims covered by federal programs like Medicare and Medicaid from this new rule.
- Prohibits health carriers from charging extra fees, penalties, or interest when collecting money back from providers.
- Defines 'retroactively deny' to include demanding repayment, reducing current payments owed, withholding future payments, or affecting future claim amounts.
Who it affects
- Health carriers operating in South Dakota
- Medical service providers who receive claim payments
Limits and unknowns
- This law only applies to medical services provided on or after July 1, 2026.
- The rule does not cover dental services, pharmaceutical services, or prescription drug products.
- Claims involving workers' compensation and self-insured plans under federal ERISA laws are excluded.
Plain language
Terms to know
- Recoup or recover
- To take back money that was already paid out for a medical claim.
- Retroactively deny
- To cancel payment after the fact by demanding repayment, reducing current payments owed, withholding future funds, or affecting future claims in any other way.
Official record
Sources
Official summary
limit the ability of a health carrier to recoup, recover, or retroactively deny previously paid claims.
Official activity
Bill history
- Signed by the Governor