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054.00.85-4. Persons Not Covered

AR ADC 054.00.85-4Arkansas Administrative Code

West's Arkansas Administrative Code
Title 054. Insurance Department
Division 00.
Rule 85. Recoupment
Ark. Admin. Code 054.00.85-4
054.00.85-4. Persons Not Covered
Currentness
a. If a health care insurer determines that payment was made for services not covered under the covered person's health insurance coverage, the health care insurer shall give written notice to the health care provider of its intent to exercise recoupment and may:
(1) Request a refund from the health care provider; or
(2) Make a recoupment of the payment from the health care provider in accordance with Section 5.
b. (1) Except in the case of fraud committed by the health care provider or as provided in subdivision b.(2) of this section, subsection a. of this section shall not apply if a health care provider or other party on its behalf verified from the health care insurer or its agent that an individual was a covered person and if the health care provider in good faith provided services to the individual in reliance on the verification.
(2) A health care insurer has one hundred twenty (120) days from the date of payment to notify the provider of a verification error and the fact that services rendered will not be covered if the error was made in good faith at the time of the verification.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.85-4, AR ADC 054.00.85-4
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