{"data":{"id":"us-pa/40-pa.c.s.-3804","jurisdiction":"us-pa","citation":"40 Pa.C.S. § 3804","heading":"Exceptions to retroactive denial of reimbursement.","body":"The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply:\n(1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter.\n(2) The claim submitted to the insurer was a duplicate claim.\n(3) Denial was required by a Federal or State government plan.\n(4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.","path":["Title 40 - INSURANCE","PART II REGULATION OF INSURERS AND RELATED PERSONS GENERALLY","CHAPTER 38 RETROACTIVE DENIAL OF REIMBURSEMENTS"],"source_url":"https://www.palegis.us/statutes/consolidated/view-statute?txtType=HTM\u0026ttl=40\u0026div=0\u0026chpt=38\u0026sctn=4\u0026subsctn=0","current_through":"2024-08-21 (Statute Update stamp, 40 Pa.C.S.)","vintage":"","retrieved_at":"2026-09-02T16:33:08Z","sha256":"6b7bde242a446379eb818804d048ed11a9da66e90c2d0a6d6109f4fa857221a2","source_id":"us-pa","stale":false,"prev":"us-pa/40-pa.c.s.-3803","next":"us-pa/40-pa.c.s.-3805"},"notice":"GroundRules: Original legal text. Not legal advice."}