Regards timing of health insurer recoupment from providers

Health providers get stronger overpayment protections

Ohio law makes insurer payments to health care providers final after one year instead of two, except for provider fraud. Payers must start recovering overpayments within one year after payment. Written notices must identify the patient, service dates, overpaid amount, and claim number or other relevant numbers. Notices must explain the overpayment, payment method and date, any applicable check number, appeal deadline, and planned recovery method. Payers can send notices electronically through an established system used by both parties. Providers have 60 days after the notice is issued to respond and can appeal without a fee. Payers must consider timely appeals. If providers miss the deadline or lose their appeal, payers can deduct the money from other payments or use other legal remedies. Contract terms that contradict these protections are unenforceable, including contracts with providers or beneficiaries.