Office of the Revisor of Statutes
SF 3214
Introduction - 94th Legislature (2025 - 2026)
Posted on 04/03/2025 09:24 a.m.
1.8 1.9 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 2.1 2.2 2.3 2.4 2.5 2.6 2.7
A bill for an act
relating to health insurance; limiting the time period for adjustment or recoupment
of health care provider reimbursement; requiring health plan companies and
third-party administrators adjusting or recouping payment related to coordination
of benefits to provide a written statement; amending Minnesota Statutes 2024,
section 62Q.75, subdivision 4.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
Section 1.
Minnesota Statutes 2024, section 62Q.75, subdivision 4, is amended to read:
Subd. 4.
Claims adjustment timeline.
(a) Once a clean claim, as defined in deleted text begin section
deleted text end deleted text begin 62Q.75,deleted text end subdivision 1deleted text begin ,deleted text end has been paid, the contract must provide a deleted text begin 12-monthdeleted text end new text begin six-monthnew text end
deadline on all adjustments to and recoupments of the payment with the exception of
payments related to coordination of benefits, deleted text begin subrogation, duplicate claims, retroactive
terminations, and cases of fraud and abusedeleted text end new text begin for which the contract must provide a 12-month
deadlinenew text end .new text begin Health plan companies and third-party administrators are prohibited from adjusting
or recouping payments after the deadlines described in this paragraph.
new text end
(b) Paragraph (a) deleted text begin shalldeleted text end new text begin doesnew text end not apply tonew text begin :
new text end
new text begin (1)new text end pharmacy contracts entered into between or on behalf of health plan companiesdeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(2) payments related to cases of fraud and abuse.
new text end
new text begin
(c) A health plan company or third-party administrator that adjusts or recoups payment
related to coordination of benefits must provide the health care provider with a written
statement specifying the basis for the adjustment or recoupment. The written statement must
provide the name and address of the entity acknowledging responsibility for payment of
the adjusted or recouped claim.
new text end
new text begin
(d) If a health plan company or third-party administrator adjusts or recoups payment
related to coordination of benefits, the health care provider has 180 days after the date of
the adjustment or recoupment, unless the health plan company or third-party administrator
permits a longer time period, to submit a claim for reimbursement for the service to the
health plan company responsible for payment.
new text end