H.F. _____ 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 carrier 28 provides written notice of the overpayment to the dental care 29 provider no later than three hundred sixty-five calendar 30 days after the date the dental care provider received the 31 overpayment. The written notice of overpayment must identify 32 the error made in the processing or payment of the claim. 33 The written notice must state a request for recovery of the 34 overpayment or notify the dental care provider of withholding 35 -1- LSB 1682YC (6) 91 nls/ko 1/ 3

H.F. _____ or reducing a payment as required in subsection 4. 1 4. Withholding or reducing payments. A dental carrier may 2 attempt to recover an overpayment by withholding or reducing a 3 payment to a dental care provider for a different claim if the 4 dental carrier provides the dental care provider with written 5 notice within one calendar day after the date of withholding 6 or reducing the payment for the other claim. The notice must 7 identify the original claim that was overpaid, the claim being 8 withheld or reduced, and the amount being withheld or reduced 9 for the overpayment and recovery. A dental carrier may include 10 the notice required by this subsection as part of the notice 11 required by subsection 3. 12 5. Applicability. Subsection 3 shall not apply, and a 13 dental carrier shall be entitled to recover an overpayment, 14 if the overpayment recovery efforts are based on a reasonable 15 belief of fraud, abuse, or other intentional misconduct. 16 6. Waiver prohibited. The requirements of this section 17 shall not be waived by contract. Any contract contrary to this 18 section shall be null and void. 19 7. Rules. The commissioner of insurance may adopt rules 20 pursuant to chapter 17A to administer this section. 21 EXPLANATION 22 The inclusion of this explanation does not constitute agreement with 23 the explanation’s substance by the members of the general assembly. 24 This bill relates to the recovery of an overpayment of a 25 claim by a dental carrier. 26 Under the bill, a carrier shall establish written policies 27 and procedures for a provider to appeal an overpayment 28 recovery or overpayment recovery request. “Overpayment” is 29 defined in the bill. A carrier shall notify a provider of the 30 policies and procedures to appeal the overpayment recovery or 31 overpayment recovery request, and such policies and procedures 32 must allow a provider to appeal such recovery or request within 33 a minimum of 90 calendar days after the notice is received. 34 The policies and procedures also must allow the provider 35 -2- LSB 1682YC (6) 91 nls/ko 2/ 3

H.F. _____ to access the claim information that is the subject of the 1 overpayment dispute. 2 A carrier shall not attempt to recover an overpayment made 3 to a provider unless, no later than 365 calendar days after 4 the date the provider receives the overpayment, the carrier 5 provides written notice of the overpayment to the provider 6 identifying the error made in the processing or payment, and 7 stating a request for recovery of the overpayment or notice of 8 withholding or reducing a payment to the provider. 9 A carrier may attempt to recover an overpayment by 10 withholding or reducing payment to a provider for a different 11 claim if the carrier notifies the provider in writing within 12 one calendar day after the date of withholding or reducing the 13 payment for the other claim. The notice must identify the 14 original claim that was overpaid, the claim being withheld 15 or reduced, and the amount being withheld or reduced for the 16 overpayment and recovery. 17 The requirements of the bill shall not be waived by contract. 18 Any contract contrary to the bill shall be null and void. The 19 commissioner of insurance may adopt rules pursuant to Code 20 chapter 17A to administer the bill. 21 -3- LSB 1682YC (6) 91 nls/ko 3/ 3