limit the ability of a health carrier to recoup, recover, or retroactively deny previously paid claims.

Establishes an 18-month time limit from the date of payment for health carriers to recoup, recover, or retroactively deny previously paid claims, provided they give written notice of the reason to the provider.

Requires that any payment returned by providers to health carriers must equal the original payment amount and cannot include additional fees, penalties, or interest.

Creates seven specific exceptions where the 18-month limitation does not apply, including fraudulent claims, adjustments with different payors, casualty insurance, ERISA plans, federal programs (Medicare/Medicaid), workers' compensation, and duplicate payments.

Defines 'medical services' to exclude dental services, pharmaceutical services, and prescription drug products or supplies.

Defines 'retroactively deny a previously paid claim' to include requiring repayment, reducing current payments, withholding future payments, or any other method of affecting future claim payments.

Makes violations of the new section subject to enforcement by the Division of Insurance under title 58 of the South Dakota Code.

Sets the effective date of the act as July 1, 2026, for claims for medical services provided on or after that date.