KRS 304.17A-708: Resolution of payment errors -- Retroactive denial of claims --

Conditions.

(1) An insurer shall not require a provider to appeal errors in payment where the insurer

has not paid the claim according to the contracted rate. Miscalculations in payme nts

made by the insurer shall be corrected and paid within thirty (30) calendar days

upon the insurer's receipt of documentation from the provider verifying the error.

(2) An insurer shall not be required to correct a payment error to a provider if the

provider's request for a payment correction is filed more than twenty -four (24)

months after the date that the provider received payment for the claim from the

insurer.

(3) (a) Except in cases of fraud, an insurer may only retroactively deny

reimbursement to a provider during the twenty -four (24) month period after

the date that the insurer paid the claim submitted by the provider.

(b) An insurer that retroactively denies reimbursement to a provider under this

section shall give the provider a written or elect ronic statement specifying the

basis for the retroactive denial.

(c) If the retroactive denial of reimbursement results from coordination of

benefits, the written statement shall specify the name and address of the entity

acknowledging responsibility for payment of the denied claim.

(d) If an insurer retroactively denies reimbursement for services as a result of

coordination of benefits with another insurer, the provider shall have twelve

(12) months from the date that the provider received notice of the de nial,

unless the insurer that retroactively denied reimbursement permits a longer

period, to submit a claim for reimbursement for the service to the insurer, the

medical assistance program, or the Medicare program responsible for

payment.