Sec. 1. 24-A MRSA §4303, sub-§3-C is enacted to read:

3-C.__Notice of amendments to provider agreements.__A carrier offering a health plan in this State shall notify participating providers and provide them with copies of proposed amendments to provider agreements at least 90 days prior to their proposed effective date.

Sec. 2. 24-A MRSA §4304, sub-§§4-A and 4-B are enacted to read:

4-A.__Limits on pursuit of refunds.__A carrier offering a health plan in this State may have no more than 90 days after making payment to a provider for a claim or bill for medical services rendered to request a refund or partial refund of the payment, unless fraudulent or materially incorrect information was provided at the time of submission of the claim.__If a carrier requests a refund or partial refund, the carrier shall provide written notice to the provider of the reasons for the refund or partial refund request, identify each previously paid claim for which a refund or partial refund is sought and describe the reason that the refund or partial refund is being sought.__A carrier may not attempt to recover the requested refund or partial refund by withholding or reducing another payment that is owed by the carrier.

4-B.__Prohibition on changes to procedural coding.__A carrier offering a health plan in this State may not change the procedural code assigned to a medical service in a claim submitted by a provider.__The carrier shall either accept the procedural code assigned by the provider and pay the provider or deny the procedural code.

SUMMARY

The bill requires health insurers to give providers 90 days' written notice of any amendments to provider contracts. It requires health insurers to seek refunds or partial refunds of previously paid claims within 90 days of submission. Finally, it prohibits health insurers from changing the procedural coding decisions made by providers.