IL SB2771

Insurers, health maintenance organizations, independent practice associations, and physician hospital organizations may not attempt recoupment or offset until all appeal rights of health care professionals and providers are exhausted.

Health care providers must receive remittance advice with detailed recoupment explanations including patient name, date of service, service code, recoupment amount, and reason for the recoupment.

Recoupment or offset cannot be requested or withheld from future payments 6 months or more after the original payment is made, except in cases of fraud findings, Comprehensive Health Insurance Plan administration, or when providers have been paid by other payers.

Health care professionals or providers may appeal a recoupment or offset within 60 days after receipt of the remittance advice, and the insurer must provide a telephone number or mailing address for initiating appeals.

The act takes effect January 1, 2021.