Revises provisions relating to Medicaid. (BDR 57-290)
What changed between versions
Changed the deadline for insurers to respond to Medicaid claims from 3 years after service provision to 60 days after receiving the inquiry.
Added requirement that insurers must treat Medicaid as having valid assignment of insured benefits even without a written assignment.
Added specific protections against denying claims based on lack of prior authorization when the state agency authorized the service.
Added protections against denying claims based on claim submission date, form type, or documentation format issues.
Added specific timeframes for enforcing Medicaid rights: claims must be submitted within 3 years and enforcement actions commenced within 6 years of submission.
Added definition of 'insurer' to include self-insured plans, ERISA plans, and other parties legally responsible for health care payment claims.