KRS 304.17A-714: Collection of claim overpayments -- Dispute resolution.

(1) Except for overpayments which are a result of an error in the payment rate or

method, an insurer that determines that a provider was overpaid shall, within

twenty-four (24) months from the date that the insurer paid the claim, provide

written or electronic notice to the provider of the amount of the overpayment, the

covered person's name, patient identification number, date of service to which the

overpayment applies, insurer reference number for the claim, and the basis for

determining that an overpayment exists. Electronic notice includes e -mail or

facsimile where the provider agreed in advance in writing to receive such notices.

The insurer shall either:

(a) Request a refund from the provider; or

(b) Indicate on the notice that, within thirty (30) calenda r days from the postmark

date or electronic delivery date of the insurer's notice, if the insurer does not

receive a notice of provider dispute in accordance with subsection (2) of this

section, the amount of the overpayment will be recouped from future

payments.

(2) If a provider disagrees with the amount of the overpayment, the provider shall

within thirty (30) calendar days from the postmark date or the electronic delivery

date of the insurer's written notice dispute the amount of the overpayment by

submitting additional information to the insurer.

(3) If a provider files a dispute in accordance with subsection (2) of this section, no

recoupment shall be made until the dispute is resolved. If a provider does not

dispute the amount of the overpayment and does not provide a refund as required in

subsection (2) of this section, the insurer may recoup the amount due from future

payments.

(4) All disputes submitted by providers pursuant to subsection (2) of this section shall

be processed in accordance and comp leted within thirty (30) days with the insurer's

provider appeals process.

(5) An insurer may recover an overpayment resulting from an error in the payment rate

or method by requesting a refund from the provider or making a recoupment of the

overpayment from the provider, subject to the provisions of subsection (6) of this

section. A provider may dispute such recoupment in accordance with the provisions

contained in KRS 304.17A-708.

(6) If an insurer chooses to collect an overpayment made to a provider thro ugh a

recoupment against future provider payments, the insurer shall, within twenty -four

(24) months from the date that the insurer paid the claim, and at the actual time of

recoupment give the provider written or electronic documentation that specifies:

(a) The amount of the recoupment;

(b) The covered person's name to whom the recoupment applies;

(c) Patient identification number; and

(d) Date of service.