{"data":{"id":"us-ky/krs-304.17a-708","jurisdiction":"us-ky","citation":"KRS 304.17A-708","heading":"Resolution of payment errors -- Retroactive denial of claims --","body":"Conditions.\n(1) An insurer shall not require a provider to appeal errors in payment where the insurer\nhas not paid the claim according to the contracted rate. Miscalculations in payme nts\nmade by the insurer shall be corrected and paid within thirty (30) calendar days\nupon the insurer's receipt of documentation from the provider verifying the error.\n(2) An insurer shall not be required to correct a payment error to a provider if the\nprovider's request for a payment correction is filed more than twenty -four (24)\nmonths after the date that the provider received payment for the claim from the\ninsurer.\n(3) (a) Except in cases of fraud, an insurer may only retroactively deny\nreimbursement to a provider during the twenty -four (24) month period after\nthe date that the insurer paid the claim submitted by the provider.\n(b) An insurer that retroactively denies reimbursement to a provider under this\nsection shall give the provider a written or elect ronic statement specifying the\nbasis for the retroactive denial.\n(c) If the retroactive denial of reimbursement results from coordination of\nbenefits, the written statement shall specify the name and address of the entity\nacknowledging responsibility for payment of the denied claim.\n(d) If an insurer retroactively denies reimbursement for services as a result of\ncoordination of benefits with another insurer, the provider shall have twelve\n(12) months from the date that the provider received notice of the de nial,\nunless the insurer that retroactively denied reimbursement permits a longer\nperiod, to submit a claim for reimbursement for the service to the insurer, the\nmedical assistance program, or the Medicare program responsible for\npayment.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=29333","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:48Z","sha256":"08ab58284a43b25b406fc7e456064ca7ed4cd8714b715d4cc4a5152022faa7c5","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-706","next":"us-ky/krs-304.17a-710"},"notice":"GroundRules: Original legal text. Not legal advice."}