MS HB752

Requires dental service contractors and dental insurance contracts to establish appeal procedures for claim denials based on lack of medical necessity, with determinations made by independent licensed dentists in the same specialty.

Prohibits denial of claims for procedures specifically included in prior authorizations unless one of five circumstances applies: benefit limits reached, claim documentation fails to support authorization, patient's condition changed, plan terms no longer support procedure, or specific payment/eligibility issues exist.

Requires dental service contractors to issue prior authorization decisions within 30 days of request and prohibits requiring additional information for prior authorization that would not be required for claim submission.

Prohibits recoupment of claims solely due to patient's loss of coverage or ineligibility if the contractor erroneously confirmed coverage at time of treatment despite having sufficient information showing ineligibility.

Effective July 1, 2019.