SB 1328 Health insurance; fair business practices.
Richard L. Saslaw | all patrons    ...    notes
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Summary as introduced:
Health insurance; fair business practices. Provides that the "retroactive denial of a previously paid claim" or "retroactive denial of payment" includes any attempt by a carrier to deny or adjust a claim after it has been paid, or collect from the provider any sums previously paid to the provider with respect to a claim that the carrier had approved, unless the carrier has based such denial or adjustment on information specific to that claim, and not on an extrapolation of the results of an audit of a sample of other claims. The measure also prohibits a carrier from (i) seeking to collect alleged overpayments from a provider with respect to any claim or claims previously paid if the carrier's allegation of overpayment is based on an extrapolation of the results of an audit of a sample of a provider's claims to other, unaudited claims or (ii) conducting an audit of a provider's claims unless the State Corporation Commission has determined that the methods and procedures pursuant to which the audit is conducted are fair and equitable.

Full text:
01/17/03  Senate: Presented & ordered printed 030335528  pdf | impact statement

01/17/03  Senate: Unanimous consent to introduce
01/17/03  Senate: Presented & ordered printed 030335528
01/17/03  Senate: Referred to Committee on Commerce and Labor
01/27/03  Senate: Stricken at request of Patron in Commerce and Labor by voice vote