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§ 3804. Exceptions to retroactive denial of reimbursement

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 40 Pa.C.S.A. InsuranceEffective: January 3, 2017

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 40 Pa.C.S.A. Insurance (Refs & Annos)
Part II. Regulation of Insurers and Related Persons Generally (Refs & Annos)
Chapter 38. Retroactive Denial of Reimbursements
Effective: January 3, 2017
40 Pa.C.S.A. § 3804
§ 3804. Exceptions to retroactive denial of reimbursement
Currentness
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 abuse as defined in this chapter.
(2) The claim submitted to the insurer was a duplicate claim.
(3) Denial was required by a Federal or State government plan.
(4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.

Credits

2016, Nov. 4, P.L. 1144, No. 146, § 1, effective in 60 days [Jan. 3, 2017].
40 Pa.C.S.A. § 3804, PA ST 40 Pa.C.S.A. § 3804
Current through Act 11 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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