Iowa HF 637: A bill for an act relating to the recovery of overpayment of a claim by a dental carrier.

Bill Text

House
File
637
-
Introduced

HOUSE
FILE
637

BY
COMMITTEE
ON
COMMERCE

(SUCCESSOR
TO
HSB
190)

A
BILL
FOR

An
Act
relating
to
the
recovery
of
overpayment
of
a
claim
by
a
1

dental
carrier.
2

BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3

TLSB
1682HV
(3)
91

nls/ko

H.F.
637

Section
1.
NEW
SECTION
.
514C.3D
Dental
carrier
——
recovery
1

of
claim
overpayment.
2

1.
Definitions.
As
used
in
this
section,
unless
the
context
3

otherwise
provides:
4

a.
“Dental
care
provider”
means
the
same
as
defined
in
5

section
514C.3C.
6

b.
“Dental
care
services”
means
the
same
as
defined
in
7

section
514C.3C.
8

c.
“Dental
carrier”
means
the
same
as
defined
in
section
9

514C.3C.
10

d.
“Overpayment”
means
a
payment
made
in
error
by
a
dental
11

carrier
to
a
dental
provider
for
a
dental
care
service.
12

2.
Appeals.
A
dental
carrier
shall
establish
written
13

policies
and
procedures
for
a
dental
care
provider
to
appeal
14

an
overpayment
recovery
or
overpayment
recovery
request
made
15

by
the
dental
carrier.
The
dental
carrier
shall
notify
the
16

dental
care
provider
of
the
policies
and
procedures
to
appeal
17

an
overpayment
recovery
or
overpayment
recovery
request
at
the
18

time
that
the
dental
carrier
makes
the
overpayment
recovery
or
19

overpayment
recovery
request.
The
policies
and
procedures
must
20

allow
a
dental
care
provider
to
appeal
an
overpayment
recovery
21

or
overpayment
recovery
request
within
a
minimum
of
ninety
22

calendar
days
after
the
dental
care
provider
receives
such
23

notice.
The
policies
and
procedures
must
allow
the
dental
care
24

provider
to
access
the
claim
information
that
is
the
subject
of
25

the
overpayment
dispute.
26

3.
Notice.
A
dental
carrier
shall
not
attempt
to
recover
27

an
overpayment,
in
whole
or
in
part,
unless
the
dental
28

carrier
provides
written
notice
of
the
overpayment
to
the
29

dental
care
provider
no
later
than
three
hundred
sixty-five
30

calendar
days
after
the
date
the
dental
care
provider
received
31

the
overpayment.
The
written
notice
of
overpayment
must
32

identify
the
error
made
in
the
processing
or
payment
of
the
33

claim.
The
written
notice
must
state
a
request
for
recovery
34

of
the
overpayment
or
notify
the
dental
care
provider
of
35

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LSB
1682HV
(3)
91

nls/ko
1/
3

H.F.
637

withholding
or
reducing
a
payment
as
required
in
subsection
1

4.
If
a
recovery
attempt
is
made
pursuant
to
subsection
4,
2

then
the
dental
carrier
shall
be
deemed
to
have
met
the
notice
3

requirements
of
this
subsection.
4

4.
Withholding
or
reducing
payments.
A
dental
carrier
may
5

attempt
to
recover
an
overpayment
by
withholding
or
reducing
a
6

payment
to
a
dental
care
provider
for
a
different
claim
if
the
7

dental
carrier
provides
the
dental
care
provider
with
written
8

notice
within
twenty-eight
calendar
days
after
the
date
of
9

withholding
or
reducing
the
payment
for
the
other
claim.
The
10

notice
must
identify
the
original
claim
that
was
overpaid,
11

the
amount
being
withheld
or
reduced
for
the
overpayment
and
12

recovery,
and
the
payment
from
which
such
amount
is
being
13

withheld
or
reduced.
A
dental
carrier
may
include
the
notice
14

required
by
this
subsection
as
part
of
the
notice
required
by
15

subsection
3.
16

5.
Applicability.
Subsections
3
and
4
shall
not
apply,
and
17

a
dental
carrier
shall
be
entitled
to
recover
an
overpayment,
18

if
the
overpayment
recovery
efforts
are
based
on
a
reasonable
19

belief
of
fraud,
abuse,
or
other
intentional
misconduct.
20

6.
Waiver
prohibited.
The
requirements
of
this
section
21

shall
not
be
waived
by
contract.
Any
contract
contrary
to
this
22

section
shall
be
null
and
void.
23

7.
Rules.
The
commissioner
of
insurance
may
adopt
rules
24

pursuant
to
chapter
17A
to
administer
this
section.
25

EXPLANATION
26

The
inclusion
of
this
explanation
does
not
constitute
agreement
with
27

the
explanation’s
substance
by
the
members
of
the
general
assembly.
28

This
bill
relates
to
the
recovery
of
an
overpayment
of
a
29

claim
by
a
dental
carrier.
30

Under
the
bill,
a
carrier
shall
establish
written
policies
31

and
procedures
for
a
provider
to
appeal
an
overpayment
32

recovery
or
overpayment
recovery
request.
“Overpayment”
is
33

defined
in
the
bill.
A
carrier
shall
notify
a
provider
of
the
34

policies
and
procedures
to
appeal
the
overpayment
recovery
or
35

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1682HV
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nls/ko
2/
3

H.F.
637

overpayment
recovery
request,
and
such
policies
and
procedures
1

must
allow
a
provider
to
appeal
such
recovery
or
request
within
2

a
minimum
of
90
calendar
days
after
the
notice
is
received.
3

The
policies
and
procedures
also
must
allow
the
provider
4

to
access
the
claim
information
that
is
the
subject
of
the
5

overpayment
dispute.
6

A
carrier
shall
not
attempt
to
recover
an
overpayment
made
7

to
a
provider
unless,
no
later
than
365
calendar
days
after
8

the
date
the
provider
receives
the
overpayment,
the
carrier
9

provides
written
notice
of
the
overpayment
to
the
provider
10

ide