HB1484 (2020) Detail

Relative to retroactive denials of previously paid claims.


HB 1484 - AS INTRODUCED

 

 

2020 SESSION

20-2640

01/05

 

HOUSE BILL 1484

 

AN ACT relative to retroactive denials of previously paid claims.

 

SPONSORS: Rep. Read, Rock. 17; Rep. Abrami, Rock. 19; Rep. Luneau, Merr. 10; Rep. Ellison, Merr. 27; Sen. Fuller Clark, Dist 21; Sen. Hennessey, Dist 5; Sen. Reagan, Dist 17; Sen. Bradley, Dist 3

 

COMMITTEE: Commerce and Consumer Affairs

 

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ANALYSIS

 

This bill clarifies the law regarding retroactive denials of previously paid claims under accident and health insurance.

 

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

20-2640

01/05

 

STATE OF NEW HAMPSHIRE

 

In the Year of Our Lord Two Thousand Twenty

 

AN ACT relative to retroactive denials of previously paid claims.

 

Be it Enacted by the Senate and House of Representatives in General Court convened:

 

1  Accident and Health Insurance; Retroactive Denials.  Amend RSA 415:6-i, II to read as follows:

II.  No insurer shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless:  

(a)  The insurer has provided the reason for the retroactive denial in writing to the health care provider; and

(b)  [The time which has elapsed since the date of payment of the challenged claim does not exceed 18 months.  The retroactive denial of a previously paid claim may be permitted beyond 18 months from the date of payment only for the following reasons:

(b)]  The time which has elapsed since the date of payment of the challenged claim does not exceed 12 months.  The retroactive denial of a previously paid claim may be permitted beyond 12 months from the date of payment only for the following reasons:

(1)  The claim was submitted fraudulently;

(2)  The claim payment was incorrect because the health care provider or the insured was already paid for the health care services identified in the claim; or

(3)  The health care services identified in the claim were not delivered by the health care provider;

[(4)  The claim payment was for services covered by Title XVIII, Title XIX, or Title XXI of the Social Security Act;

(5)  The claim payment is the subject of an adjustment with a different insurer, administrator, or payor and such adjustment is not affected by a contractual relationship, association, or affiliation involving claims payment, processing, or pricing; or

(6)  The claim payment is the subject of legal action].

II-a.  If the claim payment is identified as being the responsibility of a different insurer, administrator, or payor, the payer shall then recover payment from the correctly identified insurer or the insured and not from the provider of services.

2  Effective Date.  This act shall take effect 60 days after its passage.

Links

HB1484 at GenCourtMobile
HB1484 Discussion

Action Dates

Date Body Type
Feb. 5, 2020 House Hearing
March 3, 2020 House Exec Session

Bill Text Revisions

HB1484 Revision: 7179 Date: Dec. 3, 2019, 10:21 a.m.

Docket

Date Status
Jan. 8, 2020 Introduced 01/08/2020 and referred to Commerce and Consumer Affairs HJ 1 P. 24
Feb. 5, 2020 Public Hearing: 02/05/2020 10:30 am LOB 302
Feb. 18, 2020 Subcommittee Work Session: 02/18/2020 09:30 am LOB 302
Feb. 24, 2020 ==TIME CHANGE== Subcommittee Work Session: 02/24/2020 09:00 am LOB 302
March 3, 2020 Executive Session: 03/03/2020 10:30 am LOB 302