§ 23-63-1803 — Persons not covered

(a) If a healthcare insurer determines that payment was made for services not covered under the covered person's health insurance coverage, the healthcare insurer shall give written notice to the healthcare provider of its intent to exercise recoupment and may: (1) Request a refund from the healthcare provider; or (2) Make a recoupment of the payment from the healthcare provider in accordance with § 23-63-1804 . (b) (1) Except in the case of fraud committed by the healthcare provider or as provided in subdivision (b)(2) of this section, subsection (a) of this section shall not apply if a healthcare provider or other party on its behalf verified from the healthcare insurer or its agent that an individual was a covered person and if the healthcare provider in good faith provided services to the individual in reliance on the verification. (2) A healthcare 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.

Legislative History

Acts 2005, No. 422, § 1.