MA S770

Requires health insurers to pay for services ordered by treating providers when the services are covered benefits and follow the carrier's clinical review criteria, and prohibits denial of properly authorized medically necessary services.

Prohibits insurers from denying claims based on administrative or technical defects unless there is reasonable basis to believe the claim was fraudulently submitted.

Limits insurers to 12 months after original payment to recoup funds, and restricts recoupment to 90 days for retroactively terminated or disenrolled patients if the provider verified eligibility at the time of service.

Requires insurers seeking recoupment to provide detailed written notice identifying each claim and give providers 30 days to challenge the request before any adjustment is made.

Establishes a 30-day retrospective medical necessity review process for claims denied due to unintentional authorization errors, requiring reversal and payment if services are deemed medically necessary.