MN SF2700

Health plan companies cannot require providers to give termination notice before discussing contract renewals and cannot communicate with enrollees about possible termination until final notice is received from the provider.

Health plan companies must provide requested fee schedules and pricing information to participating providers, excluding pharmacy benefits, either in contract renewal documents or through a secure web portal.

Health plan companies using tiered provider networks must explain to providers upon request the methodology for tier ranking based on cost and quality, with tier assignments notified to providers before the tiered product takes effect.

Claims must be submitted within 6 months from the date of service (extendable to 12 months for significant operational disruptions), and health plan companies have a 12-month deadline for adjusting or recouping claim payments, excluding coordination of benefits, subrogation, fraud, and duplicate claims.

Health plan companies cannot prohibit providers from collecting deductibles and coinsurance at or before service, and providers must return patient overpayments within 30 days of claim adjudication.