H.F. 637 Section 1. NEW SECTION . 514C.3D Dental carrier —— recovery 1 of claim overpayment. 2 1. Definitions. As used in this section, unless the context 3 otherwise provides: 4 a. “Dental care provider” means the same as defined in 5 section 514C.3C. 6 b. “Dental care services” means the same as defined in 7 section 514C.3C. 8 c. “Dental carrier” means the same as defined in section 9 514C.3C. 10 d. “Overpayment” means a payment made in error by a dental 11 carrier to a dental provider for a dental care service. 12 2. Appeals. A dental carrier shall establish written 13 policies and procedures for a dental care provider to appeal 14 an overpayment recovery or overpayment recovery request made 15 by the dental carrier. The dental carrier shall notify the 16 dental care provider of the policies and procedures to appeal 17 an overpayment recovery or overpayment recovery request at the 18 time that the dental carrier makes the overpayment recovery or 19 overpayment recovery request. The policies and procedures must 20 allow a dental care provider to appeal an overpayment recovery 21 or overpayment recovery request within a minimum of ninety 22 calendar days after the dental care provider receives such 23 notice. The policies and procedures must allow the dental care 24 provider to access the claim information that is the subject of 25 the overpayment dispute. 26 3. Notice. A dental carrier shall not attempt to recover 27 an overpayment, in whole or in part, unless the dental 28 carrier provides written notice of the overpayment to the 29 dental care provider no later than three hundred sixty-five 30 calendar days after the date the dental care provider received 31 the overpayment. The written notice of overpayment must 32 identify the error made in the processing or payment of the 33 claim. The written notice must state a request for recovery 34 of the overpayment or notify the dental care provider of 35 -1- LSB 1682HV (3) 91 nls/ko 1/ 3

H.F. 637 withholding or reducing a payment as required in subsection 1 4. If a recovery attempt is made pursuant to subsection 4, 2 then the dental carrier shall be deemed to have met the notice 3 requirements of this subsection. 4 4. Withholding or reducing payments. A dental carrier may 5 attempt to recover an overpayment by withholding or reducing a 6 payment to a dental care provider for a different claim if the 7 dental carrier provides the dental care provider with written 8 notice within twenty-eight calendar days after the date of 9 withholding or reducing the payment for the other claim. The 10 notice must identify the original claim that was overpaid, 11 the amount being withheld or reduced for the overpayment and 12 recovery, and the payment from which such amount is being 13 withheld or reduced. A dental carrier may include the notice 14 required by this subsection as part of the notice required by 15 subsection 3. 16 5. Applicability. Subsections 3 and 4 shall not apply, and 17 a dental carrier shall be entitled to recover an overpayment, 18 if the overpayment recovery efforts are based on a reasonable 19 belief of fraud, abuse, or other intentional misconduct. 20 6. Waiver prohibited. The requirements of this section 21 shall not be waived by contract. Any contract contrary to this 22 section shall be null and void. 23 7. Rules. The commissioner of insurance may adopt rules 24 pursuant to chapter 17A to administer this section. 25 EXPLANATION 26 The inclusion of this explanation does not constitute agreement with 27 the explanation’s substance by the members of the general assembly. 28 This bill relates to the recovery of an overpayment of a 29 claim by a dental carrier. 30 Under the bill, a carrier shall establish written policies 31 and procedures for a provider to appeal an overpayment 32 recovery or overpayment recovery request. “Overpayment” is 33 defined in the bill. A carrier shall notify a provider of the 34 policies and procedures to appeal the overpayment recovery or 35 -2- LSB 1682HV (3) 91 nls/ko 2/ 3

H.F. 637 overpayment recovery request, and such policies and procedures 1 must allow a provider to appeal such recovery or request within 2 a minimum of 90 calendar days after the notice is received. 3 The policies and procedures also must allow the provider 4 to access the claim information that is the subject of the 5 overpayment dispute. 6 A carrier shall not attempt to recover an overpayment made 7 to a provider unless, no later than 365 calendar days after 8 the date the provider receives the overpayment, the carrier 9 provides written notice of the overpayment to the provider 10 identifying the error made in the processing or payment, and 11 stating a request for recovery of the overpayment or notice of 12 withholding or reducing a payment to the provider. If such a 13 recovery attempt is made, a carrier shall be deemed to have met 14 the notice requirement. 15 A carrier may attempt to recover an overpayment by 16 withholding or reducing payment to a provider for a different 17 claim if the carrier notifies the provider in writing within 18 28 calendar days after the date of withholding or reducing the 19 payment for the other claim. The notice must identify the 20 original claim that was overpaid, the amount being withheld or 21 reduced for the overpayment and recovery, and the payment from 22 which such amount is being recovered or reduced. 23 The requirements of the bill shall not be waived by contract. 24 Any contract contrary to the bill shall be null and void. The 25 commissioner of insurance may adopt rules pursuant to Code 26 chapter 17A to administer the bill. 27 -3- LSB 1682HV (3) 91 nls/ko 3/ 3