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SF3214 (Legislative Session 94 (2025-2026))

Health care provider reimbursement time period for adjustment or recoupment time period limitation provision and health plan companies and third-party administrators adjusting or recouping payment related to coordination of benefits providing a written statement requirement provision

AI Generated Summary

Purpose of the Bill

The bill aims to regulate the timeframe and procedures for adjusting or recouping health care provider reimbursements by health insurance companies and third-party administrators in Minnesota.

Main Provisions

  • Time Limit for Adjustments and Recoupments: The bill imposes a strict deadline for adjustments or recoupments of payments to health care providers after a claim has been paid. Specifically, it reduces the allowable time for such actions from 12 months to six months, with certain exceptions.
  • Exceptions: The six-month deadline does not apply to coordination of benefits, subrogation, duplicate claims, retroactive terminations, and cases involving fraud and abuse. In these instances, the original 12-month deadline remains intact.
  • Written Statement Requirement: Health plan companies and third-party administrators are required to provide a written statement when adjustments or recoupments are made due to coordination of benefits. This statement must include the basis for the adjustment or recoupment, as well as the name and address of the entity responsible for the payment of the claim.
  • Provider's Claim Submission Deadline: Health care providers have 180 days from the adjustment or recoupment date to submit a claim for reimbursement to the health plan company responsible for payment, unless a longer period is allowed by the plan.

Significant Changes to Existing Law

The bill reduces the time limit from 12 months to six months for most adjustments and recoupments, emphasizing a quicker resolution of claims for health care providers. This change aims to provide health care providers with a more predictable and manageable timeline for financial planning and reimbursement processing.

Relevant Terms

  • Health insurance
  • Reimbursement adjustment
  • Recoupment
  • Coordination of benefits
  • Fraud and abuse
  • Subrogation
  • Duplicate claims
  • Retroactive terminations
  • Health plan companies
  • Third-party administrators

Bill text versions

Actions

DateChamberWhereTypeNameCommittee Name
April 01, 2025SenateFloorActionIntroduction and first reading
April 01, 2025SenateFloorActionReferred toCommerce and Consumer Protection

Citations

 
[
  {
    "analysis": {
      "added": [
        "A written statement requirement for adjustments related to coordination of benefits."
      ],
      "removed": [
        ""
      ],
      "summary": "This bill amends the claims adjustment timeline for health care provider reimbursements under section 62Q.75, subdivision 4.",
      "modified": [
        "Reduces the adjustment and recoupment deadline from 12 months to six months for certain claims."
      ]
    },
    "citation": "62Q.75",
    "subdivision": "subdivision 4"
  }
]

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