Current through Pa Acts 2024-53, 2024-56 through 2024-92
Section 3803 - Retroactive denial of reimbursement(a)General rule.--Except as provided in section 3704 (relating to exceptions to retroactive denial of reimbursement), an insurer may not retroactively deny reimbursement as a result of an overpayment determination more than 24 months after the date the insurer initially paid the health care provider. An insurer that retroactively denies reimbursement to a health care provider under this chapter shall do so based upon coding guidelines and policies in effect at the time the service subject to the retroactive denial was rendered.(b)Written notice.--An insurer that retroactively denies reimbursement to a health care provider under subsection (a) shall provide the health care provider with a written statement specifying the basis for the retroactive denial. Added by P.L. TBD 2016 No. 146, § 1, eff. 1/3/2017.