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304.17A-714 Collection of claim overpayments -- Dispute resolution.
(1) Except for overpayments which are a result of an error in the payment rate or
method, an insurer that determines that a provider was overpaid shall, within <br>twenty-four (24) months from the date that the insurer paid the claim, provide <br>written or electronic notice to the provider of the amount of the overpayment, the <br>covered person's name, patient identification number, date of service to which the <br>overpayment applies, insurer reference number for the claim, and the basis for <br>determining that an overpayment exists. Electronic notice includes e-mail or <br>facsimile where the provider agreed in advance in writing to receive such notices. <br>The insurer shall either: <br>(a) Request a refund from the provider; or <br>(b) Indicate on the notice that, within thirty (30) calendar days from the postmark
date or electronic delivery date of the insurer's notice, if the insurer does not <br>receive a notice of provider dispute in accordance with subsection (2) of this <br>section, the amount of the overpayment will be recouped from future <br>payments.
(2) If a provider disagrees with the amount of the overpayment, the provider shall
within thirty (30) calendar days from the postmark date or the electronic delivery <br>date of the insurer's written notice dispute the amount of the overpayment by <br>submitting additional information to the insurer.
(3) If a provider files a dispute in accordance with subsection (2) of this section, no
recoupment shall be made until the dispute is resolved. If a provider does not <br>dispute the amount of the overpayment and does not provide a refund as required in <br>subsection (2) of this section, the insurer may recoup the amount due from future <br>payments.
(4) All disputes submitted by providers pursuant to subsection (2) of this section shall
be processed in accordance and completed within thirty (30) days with the insurer's <br>provider appeals process.
(5) An insurer may recover an overpayment resulting from an error in the payment rate
or method by requesting a refund from the provider or making a recoupment of the <br>overpayment from the provider, subject to the provisions of subsection (6) of this <br>section. A provider may dispute such recoupment in accordance with the provisions <br>contained in KRS 304.17A-708.
(6) If an insurer chooses to collect an overpayment made to a provider through a
recoupment against future provider payments, the insurer shall, within twenty-four <br>(24) months from the date that the insurer paid the claim, and at the actual time of <br>recoupment give the provider written or electronic documentation that specifies: <br>(a) The amount of the recoupment; <br>(b) The covered person's name to whom the recoupment applies; <br>(c) Patient identification number; and <br>(d) Date of service.
Effective: July 15, 2002
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History: Amended 2002 Ky. Acts ch. 181, sec. 15, effective July 15, 2002. -- Created
2000 Ky. Acts ch. 436, sec. 8, effective July 14, 2000.
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