Connecticut SB 341: AN ACT CONCERNING PARTICIPATION BY COVERED PERSONS, AUTHORIZED REPRESENTATIVES AND HEALTH CARE PROFESSIONALS IN UTILIZATION REVIEWS.

Bill Text

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General Assembly Raised Bill No. 341
February Session, 2026 LCO No. 2246

Referred to Committee on INSURANCE AND REAL ESTATE

Introduced by:
(INS)

AN ACT CONCERNING RETURN OF HEALTH CARE PROVIDER
PAYMENTS.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:

Section 1. Subsection (c) of section 38a-479b of the general statutes is 1
repealed and the following is substituted in lieu thereof (Effective January 2
1, 2027): 3
(c) (1) No contracting health organization shall cancel, deny or 4
demand the return of full or partial payment for an authorized covered 5
service due to administrative or eligibility error, more than [eighteen] 6
twelve months after the date of the receipt of a clean claim, except if: 7
(A) Such organization has a documented basis to believe that such 8
claim was submitted fraudulently by such provider; 9
(B) The provider did not bill appropriately for such claim based on 10
the documentation or evidence of what medical service was actually 11
provided; 12
(C) Such organization has paid the provider for such claim more than 13

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once; 14
(D) Such organization paid a claim that should have been or was paid 15
by a federal or state program; or 16
(E) The provider received payment for such claim from a different 17
insurer, payor or administrator through coordination of benefits or 18
subrogation, or due to coverage under an automobile insurance or 19
workers' compensation policy. Such provider shall have one year after 20
the date of the cancellation, denial or return of full or partial payment to 21
resubmit an adjusted secondary payor claim with such organization on 22
a secondary payor basis, regardless of such organization's timely filing 23
requirements. 24
(2) (A) Such organization shall give at least thirty days' advance 25
notice to a provider by certified mail, return receipt requested, electronic 26
mail to such electronic mail address designated by such provider or 27
facsimile of the organization's cancellation, denial or demand for the 28
return of full or partial payment pursuant to subdivision (1) of this 29
subsection. 30
(B) If such organization demands the return of full or partial payment 31
from a provider, the notice required under subparagraph (A) of this 32
subdivision shall disclose to the provider (i) the amount that is 33
demanded to be returned, (ii) the claim that is the subject of such 34
demand, and (iii) the basis on which such return is being demanded. 35
(C) Not later than thirty days after the receipt of the notice required 36
under subparagraph (A) of this subdivision, a provider may appeal such 37
cancellation, denial or demand in accordance with the procedures 38
provided by such organization. If any such organization fails to notify 39
the provider of such organization's determination on such appeal not 40
later than fifteen business days after receipt of such appeal from such 41
provider, such appeal shall be construed in favor of such provider. Any 42
demand for the return of full or partial payment shall be stayed during 43
the pendency of such appeal. 44

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(D) If there is no appeal or an appeal is denied, such provider may 45
resubmit an adjusted claim, if applicable, to such organization, not later 46
than thirty days after the receipt of the notice required under 47
subparagraph (A) of this subdivision or the denial of the appeal, 48
whichever is applicable, except that if a return of payment was 49
demanded pursuant to subparagraph (C) of subdivision (1) of this 50
subsection, such claim shall not be resubmitted. 51
(E) A provider shall have one year after the date of the written notice 52
set forth in subparagraph (A) of this subdivision to identify any other 53
appropriate insurance coverage applicable on the date of service and to 54
file a claim with such insurer, health care center or other issuing entity, 55
regardless of such insurer's, health care center's or other issuing entity's 56
timely filing requirements. 57
This act shall take effect as follows and shall amend the following
sections:

Section 1 January 1, 2027 38a-479b(c)

INS Joint Favorable