MI HB5909

Prohibits health plans from retrospectively denying previously paid claims to health professionals unless written notice is provided specifying the claim and reason for denial.

Limits retrospective claim denials to 12 months after payment, except for fraud, duplicate payments, federal program coverage (Medicare/Medicaid/CHIP), coordination of benefits adjustments, or claims subject to legal action.

Prohibits health plans from reducing other payments, withholding future payments, or offsetting against other claims in connection with a retrospective denial.

Bars retrospective denials for claims where the health plan verified benefits or eligibility at the time services were provided.

Requires written notice identifying the responsible payor when a retrospective denial involves coordination of benefits with another health plan or administrator.