§ 26.1-47-02.3 — Postpayment of dental claims - Payment recovery limitations

North Dakota § 26.1-47-02.3

• Jurisdiction: North Dakota
• Title 26.1: Insurance
• Ch. 26.1-47: Preferred Provider Organizations

Text

1. As used in this section, "dental care provider" means a licensed provider of dental care
services in this state.
2. Other than recovery for duplicate payments, a dental insurer, if engaging in
overpayment recovery efforts, shall provide written notice to the dental care provider
which identifies the error made in the processing or payment of the claim and justifies
the overpayment recovery.

3. A dental insurer shall provide a dental care provider with the opportunity to challenge
an overpayment recovery, including the sharing of claims information, and shall
establish written policies and procedures for a dental care provider to follow to
challenge an overpayment recovery.
4. A dental insurer may not initiate overpayment recovery efforts more than twelve
months after the original payment for the claim was made. This time limit does not
apply to overpayment recovery efforts that are:
a. Based on reasonable belief of fraud, abuse, or other intentional misconduct;
b. Required by, or initiated at the request of, a self-insured plan; or
c. Required by a state or federal government plan.