Ohio § 3901.387 Duplicative claims - claim information system

Ohio Statutes

§ 3901.387 — Duplicative claims - claim information system

Ohio § 3901.387

Title 39Insurance

Ch. 3901Superintendent Of Insurance

This text of Ohio § 3901.387 (Duplicative claims - claim information system) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 3901.387 (2026).

Text

(A)When a provider or beneficiary submits a duplicative claim for payment for health care services before the time periods specified in section3901.381of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with section3901.381of the Revised Code. The superintendent of insurance shall have the discretion to exclude an original claim in determining a violation under section3901.381of the Revised Code.

(B)(1) A third-party payer shall establish a system whereby a provider and a beneficiary may obtain information regarding the status of a cl

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(A) When a provider or beneficiary submits a duplicative claim for payment for health care services before the time periods specified in section3901.381of the Revised Code have elapsed for the original claim submitted, the third-party payer may deny the duplicative claim. Denials of claims determined to be duplicative by the department of insurance shall not be considered by the department in a market conduct examination of a third-party payer's compliance with section3901.381of the Revised Code. The superintendent of insurance shall have the discretion to exclude an original claim in determining a violation under section3901.381of the Revised Code.

(B)(1) A third-party payer shall establish a system whereby a provider and a beneficiary may obtain information regarding the status of a claim for payment for health care services, provided the claim is not materially deficient. A third-party payer shall inform providers and beneficiaries of the mechanisms that may be used to gain access to the system.

(2) If a third-party payer delegates the processing of payments to another entity, the third-party payer shall require the entity to comply with division (B)(1) of this section on behalf of the third-party payer.