DE HB172

Health insurers and health plans must provide written notice to healthcare providers identifying the error and justifying any overpayment recovery efforts, excluding duplicate payment recoveries.

Healthcare providers have the right to challenge overpayment recoveries and insurers must establish written policies and procedures to allow providers to challenge recovery attempts and access claims information.

Insurers cannot initiate overpayment recovery efforts more than 24 months after the original payment, except for cases involving fraud, abuse, intentional misconduct, self-insured plans, or state and federal government plans.

Provisions apply to all entities providing health insurance in Delaware including insurance companies, managed care organizations, health maintenance organizations, and third-party administrators.

The Act becomes effective 90 days after enactment and cannot be waived by contract; any conflicting contractual arrangement is null and void.