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Pennsylvania State Senate
04/25/2024 11:39 AM
Pennsylvania State Senate
https://www.legis.state.pa.us/cfdocs/Legis/CSM/showMemoPublic.cfm?chamber=S&SPick=20130&cosponId=12522
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Senate of Pennsylvania
Session of 2013 - 2014 Regular Session

MEMORANDUM

Posted: April 16, 2013 03:41 PM
From: Senator David G. Argall
To: All Senate members
Subject: Retroactive Review Legislation
 
In the near future, I will be introducing legislation that would protect health care providers from post-payment reviews by limiting insurance companies’ ability to retroactively deny reimbursement. In some cases, these reviews are conducted by insurers five years from the date of the claim being submitted to an insurance carrier.

This legislation would:
  • Protect providers from post-payment reviews by requiring insurance carriers to review treatment plans, claim forms and billing statements within a reasonable amount of time.
  • Specify that an insurer may only retroactively deny reimbursement during a 12 month period after the date the insurer paid the health care provider.
  • Require a written statement from the insurer specifying the basis for retroactive denial.

Please contact Jon Hopcraft of my office at 787-2637 or at jhopcraft@pasen.gov with any questions.


Introduced as SB998