Healthcare
Health care claims reimbursement
SB 1049 gives claimants at least 90 days to fix and resubmit correctable health care claims.
Providers and other claimants cannot lose reimbursement solely because a corrected claim misses an otherwise applicable filing deadline. The law also preserves access to plan and insurer dispute-resolution processes for these claims.
What the law does
- Requires health care service plans and health insurers to allow at least 90 calendar days after their most recent denial or overpayment notice to submit a corrected claim for a fixable defect.
- Bars plans and insurers from rejecting a timely corrected claim under this law solely for missing another claim-filing deadline.
- Makes disputes over corrected claims eligible for the plan’s or insurer’s fast, fair, and cost-effective dispute-resolution mechanism.
- Authorizes the Department of Managed Health Care, Department of Insurance, and State Department of Health Care Services to issue necessary guidance or regulations, with specified exemptions from standard rulemaking procedures.
Who it affects
- Health care service plans and health insurers.
- Health care providers and other claimants submitting reimbursement claims.