An Act To Further Limit Retrospective Denials of Previously Paid Health Insurance Claims
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4303, sub-§10, ¶B, as enacted by PL 2003, c. 218, §9, is amended to read:
B. The time that has elapsed since the date of payment of the previously paid claim does not exceed 18 12 months. The retrospective denial of a previously paid claim may be permitted beyond 18 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 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.
Effective September 20, 2007