™Your Policy Risk Impact Agent
23 chapters · 216 sections in this title.
40 Pa.C.S. § 3801 Scope of chapter
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This chapter shall not apply to reimbursements made as part of an annual contracted reconciliation of a risk-sharing arrangement under an administrative service provider contract.
40 Pa.C.S. § 3802 Definitions
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The following words and phrases when used in this chapter shall have the meanings given to them in this section unless the context clearly indicates otherwise: "Abuse." Incidents or practices of providers, physicians or suppliers of services and equipment which are inconsistent w…
40 Pa.C.S. § 3803 Retroactive denial of reimbursement
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(a) General rule.--Except as provided in section 3804 (relating to exceptions to retroactive denial of reimbursement), an insurer may not retroactively deny reimbursement as a result of an overpayment determination more than 24 months after the date the insurer initially paid the…
40 Pa.C.S. § 3804 Exceptions to retroactive denial of reimbursement
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The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply: (1) The information submitted to the insurer constitutes fraud, waste or ab…
