Pennsylvania § 3804 Exceptions to retroactive denial of reimbursement

Pennsylvania Statutes

§ 3804 — Exceptions to retroactive denial of reimbursement

Pennsylvania § 3804

Title 40INSURANCE

PartPART II

Ch. 38RETROACTIVE DENIAL OF REIMBURSEMENTS

This text of Pennsylvania § 3804 (Exceptions to retroactive denial of reimbursement) is published on Counsel Stack Legal Research, covering Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

40 Pa. Cons. Stat. § 3804 (2026).

Text

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.

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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.