May 2009
Claim adjustment periods change
The following timelines related to claim adjustment periods
have been enacted by House Bill 165. Please be aware of these timelines
and update your billing practices accordingly.
Effective May 12:
- Maximum 36 months, if the improper payment was due to a recovery by Medicare, Medicaid, Children's Health Insurance Pool (CHIP) or any other federal health care program
- Maximum 12 months, if the improper payment was due to any other reason (other than Coordination of Benefits [COB] as noted below)
Effective July 1:
- Maximum 24 months, if the improper payment was due to COB
These dates apply to Utah insurers recovering suspected overpayments as well as physicians, other health care professionals and facilities recovering suspected underpayments.
State legislators are in the midst of examining the health care delivery system in Utah as an extension of transformation discussions occurring throughout the nation. We appreciate and support their efforts. We will post relevant legislative updates in our newsletters as they become available.