MS HB1312

Requires health insurance issuers and benefit payers to have the same time limit for conducting audits and requesting reimbursement as they allow providers to submit claims.

Establishes a 12-month maximum period after payment for issuers and payers to request reimbursement for invalid or overpaid claims when no submission deadline is set.

Limits all audits of claims and payments made by or on behalf of the Division of Medicaid to a maximum of 5 years after payment of the claim.

Requires Medicaid auditors to be qualified and licensed and to follow Generally Accepted Accounting Principles and Generally Accepted Auditing Standards.

Carves out exceptions for claims involving fraud, misrepresentation, omission, or concealment, and does not apply to pharmacy audits under Section 73-21-175 et seq.