Public Law, Chapter 106, 123rd Legislature, First Regular Session

Chapter 106 S.P. 406 - L.D. 1218

An Act To Further Limit Retrospective Denials of Previously Paid Health Insurance Claims

Be it enacted by the People of the State of Maine as follows:

Sec. 1. 24-A MRSA §4303, sub-§10, ¶B, as enacted by PL 2003, c. 218, §9, is amended to read:

B. The time that has elapsed since the date of payment of the previously paid claim does not exceed 18 12 months. The retrospective denial of a previously paid claim may be permitted beyond 18 12 months from the date of payment only for the following reasons:

(1) The claim was submitted fraudulently;

(2) The claim payment was incorrect because the provider or the insured was already paid for the health care services identified in the claim;

(3) The health care services identified in the claim were not delivered by the provider;

(4) The claim payment was for services covered by Title XVIII, Title XIX or Title XXI of the Social Security Act;

(5) The claim payment is the subject of adjustment with another insurer, administrator or payor; or

(6) The claim payment is the subject of legal action.

Effective September 20, 2007

Public Laws

123rd Legislature

First Regular Session

Chapter 106

S.P. 406 - L.D. 1218