IC 27-13-36.2-8: Limitations on recouping, auditing, and correcting payment errors

Sec. 8. (a) A health maintenance organization may not, more than one hundred eighty (180) days after the date on which an overpayment on a provider claim was made to the provider by the health maintenance organization:

(1) request that the provider repay the overpayment; or

(2) adjust a subsequent claim filed by the provider as a method of obtaining reimbursement of the overpayment from the provider.

(b) A health maintenance organization may not recoup a paid claim more than one hundred eighty (180) days after the date on which the claim was initially paid.

(c) A health maintenance organization may not retroactively audit a paid claim more than three (3) years after the date on which the claim was initially paid.

(d) A health maintenance organization may not be required to correct a payment error to a provider if notice of the payment error is not provided within one hundred eighty (180) days after payment for a fully adjudicated claim is received.

(e) Subsections (a), (b), and (d) do not apply in cases of fraud by the provider, the enrollee, or the health maintenance organization with respect to the health benefits claim on which the overpayment or underpayment was made when a final determination of fraud has been made by a court.

(f) Notwithstanding subsections (a) through (d), a health maintenance organization and a hospital licensed under IC 16-21 may enter into a separate written agreement that provides for different time frames than those specified in this section.