2019 Mississippi Code
Title 83 - Insurance
Chapter 41 - Hospital and Medical Service Associations and Contracts
Article 5 - Provisions Common to Hospital, Medical, or Surgical Insurance.
§ 83-41-219. Reciprocal time limitations on health insurance claim filing and claim audits; applicability
(1) If any health insurance issuer or other health insurance benefit payer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer shall have the same time limit following payment of the claim to perform any review or audit for reconsidering the validity of the claim and requesting reimbursement for payment of an invalid claim or overpayment of a claim.
(2) If any health insurance issuer or other health insurance benefit payer does not limit the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer may not request reimbursement or offset another claim payment for reimbursement of an invalid claim or overpayment of a claim more than twelve (12) months after the payment of an invalid or overpaid claim.
(3) Nothing in this section shall apply to:
(a) Audits that were opened before July 1, 2012;
(b) Audits of pharmacies as provided in Section 73-21-175 et seq.;
(c) Claims submitted by providers for reimbursement under the Mississippi Medicaid Program, except that all audits of claims and payments made by or on behalf of the Division of Medicaid are limited to a maximum of five (5) years after final filing of the claim; and
(d) Claims submitted in the context of misrepresentation, omission, concealment, or fraud by the health care provider or other person.
