Text to be removed highlighted in red.
1 New Paragraph; Accident and Health Insurance; Retroactive Denials Prohibited; Audit of Providers Services. Amend RSA 415:6-i by inserting after paragraph I the following new paragraph:
I-a. No insurer may conduct an audit of provider services after services have been delivered but before payment has been made to such provider.
(a) In the event that an insurance company performs an audit in violation of this paragraph, the insurer shall:
(1) Promptly remit the amount charged by the provider for such services to the provider;
(2) Hold the patient harmless for any co-pay or co-insurance obligations with respect to such services; and
(3) Remit interest at a rate of 15 percent per annum from the date of service to the date of payment under subparagraph (1) and reimburse the provider for all costs incurred in enforcing this paragraph.
(b) An insurer found to have violated this paragraph waives any rights to retrospectively review the services for which the impermissible audit was conducted.
2 Effective Date. This act shall take effect 60 days after its passage.
Text to be added highlighted in green.
1 New Paragraph; Accident and Health Insurance; Retroactive Denials Prohibited; Audit of Providers Services. Amend RSA 415:6-i by inserting after paragraph I the following new paragraph:
I-a. No insurer may conduct an audit of provider services after services have been delivered but before payment has been made to such provider.
(a) In the event that an insurance company performs an audit in violation of this paragraph, the insurer shall:
(1) Promptly remit the amount charged by the provider for such services to the provider;
(2) Hold the patient harmless for any co-pay or co-insurance obligations with respect to such services; and
(3) Remit interest at a rate of 15 percent per annum from the date of service to the date of payment under subparagraph (1) and reimburse the provider for all costs incurred in enforcing this paragraph.
(b) An insurer found to have violated this paragraph waives any rights to retrospectively review the services for which the impermissible audit was conducted.
2 Effective Date. This act shall take effect 60 days after its passage.