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IA SSB1146
SB
AI Summary
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Dental carriers cannot deny claims for dental care services that were approved through prior authorization, and must reimburse providers at the contracted rate for authorized services
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Establishes specific exceptions allowing claim denial even with prior authorization, including when benefit limitations are reached after authorization, documentation fails to support the claim, the patient's dental condition changes making treatment no longer medically necessary, or fraud is involved
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Requires dental carriers to disclose to providers through online portals that a covered person's plan is state-regulated, and to include "state-regulated" on identification cards issued on or after July 1, 2025
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Limits overpayment recovery to 365 calendar days after the provider received the payment, with carriers required to provide written notice identifying the error and establish appeal procedures giving providers at least 90 days to respond
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Prohibits contractual waiver of these requirements, making any contrary contractual provisions null and void, and authorizes the commissioner of insurance to adopt administrative rules
Legislative Description
A bill for an act relating to prior authorization for dental care services, notice to dental care providers that a dental care service plan is state-regulated, and the recovery of overpayments by a dental carrier.(See SF 470.)
Last Action
Subcommittee recommends amendment and passage.
3/3/2025