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2018 Pennsylvania Consolidated Statutes
Title 40 - INSURANCE
Chapter 38 - Retroactive Denial of Reimbursements
Section 3804 - Exceptions to retroactive denial of reimbursement
Universal Citation: 40 PA Cons Stat § 3804 (2018)
§ 3804. Exceptions to retroactive denial of reimbursement.
The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply:
(1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter.
(2) The claim submitted to the insurer was a duplicate claim.
(3) Denial was required by a Federal or State government plan.
(4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.
Cross References. Section 3804 is referred to in sections 3803, 3805 of this title.
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