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

Plain English Breakdown

The official source material does not provide details on the consequences if repayment is requested after one year.

Insurance Claim Payment Rules

This bill limits how insurance companies and health maintenance organizations can adjust future claims or ask for repayment of past overpayments to healthcare providers.

What This Bill Does

• It stops insurers from adjusting future claims to get back money they paid too much on past claims.
• It sets a one-year limit for insurers to request repayment of an overpayment, instead of the previous two years.
• It applies these rules to health maintenance organizations as well.

Who It Names or Affects

• Insurance companies
• Health maintenance organizations
• Healthcare providers

Terms To Know

Provider

A healthcare provider, like a doctor or hospital, that gets paid by insurance.

Overpayment

When an insurer pays more money than they should have for a claim.

Limits and Unknowns

• The bill does not specify what happens if the one-year limit passes and repayment is still needed.
• It only changes rules about overpayments, not other aspects of insurance claims.

Official Summary Text

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

Current Bill Text

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

Payment of insurance claims.

Provides that an insurer may not adjust a subsequent claim filed by a provider as a method of obtaining reimbursement of an overpayment made by the insurer on a prior claim by the provider. Provides that a health maintenance organization may not adjust a subsequent claim filed by a provider as a method of obtaining reimbursement of an overpayment made by the health maintenance organization on a prior claim by the provider. Provides that an insurer may not, more than one year after the date on which an overpayment on a provider claim was made to the provider by the insurer, request that the provider repay the overpayment (current law is two years). Provides that a health maintenance organization may not, more than one year after the date on which an overpayment on a provider claim was made to the provider by the health maintenance organization, request that the provider repay the overpayment (current law is two years). Makes conforming changes.