A.__The carrier has provided the reason for the retrospective denial in writing to the provider; and

B.__The time that has elapsed since the date of payment of the previously paid claim does not exceed 18 months.__The retrospective denial of a previously paid claim may be permitted beyond 18 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 provider or the insured was already paid for the health care services identified in the claim;

(3)__The health care services identified in the claim were not delivered by the 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 adjustment with another insurer, administrator or payor; or

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

For purposes of this subsection, "retrospective denial of a previously paid claim" means any attempt by a carrier to retroactively collect payments already made to a provider with respect to a claim by requiring repayment of such payments, reducing other payments currently owed to the provider, withholding or setting off against future payments or reducing or affecting the future claim payments to the provider in any other manner.__The provider has 6 months from the date of notification under this subsection to determine whether the insured has other appropriate insurance that was in effect on the date of service. Notwithstanding the terms of the provider agreement, the carrier shall allow for the submission of a claim that was previously denied by another insurer because of the insured's transfer or termination of coverage.