Limits the lookback period for insurance overpayment recovery from health care providers to twelve months

Senate Bill S 5209 proposes to change the timeframe within which health plans can seek to recover overpayments from healthcare providers. It reduces the "lookback period" for initiating overpayment recovery efforts from twenty-four months to twelve months after the original payment was made. This means health plans will have a shorter window to identify and reclaim funds from providers for incorrect payments. However, the twelve-month limit does not apply if there is a reasonable belief of fraud, intentional misconduct, or abusive billing, or if the recovery is required by a self-insured plan or government program. The bill also specifies that if a provider claims underpayment, the health plan can still defend or set off with overpayments going back as far as the claimed underpayment.