MN HF3042

Health plan companies cannot require providers to give termination notice before discussing contract renewals, and cannot notify enrollees of possible termination until receiving final notice from the provider.

Nonnetwork providers cannot be barred from future network participation solely because they previously terminated a contract according to its terms.

Health plan companies must provide fee schedules upon request to participating providers, either through renewal documents or a secure web portal (excluding pharmacy claims).

When using tiered provider reimbursement, health plans must explain the methodology for tier rankings and notify providers of their tier placement before the effective date.

Contracts must include a 12-month deadline for claim adjustments and recoupments after payment, with exceptions for coordination of benefits, subrogation, duplicate claims, retroactive terminations, fraud, and abuse.

All provisions take effect January 1, 2011, applying to contracts entered into, renewed, or amended on or after that date.