MS SB2772

Establishes appeal procedures for dental service contractors to review claim denials based on lack of medical necessity, with determinations made by independent licensed dentists in the same or appropriate specialty.

Prohibits claim denials for procedures included in prior authorizations except under five specified circumstances: benefit limitations reached due to subsequent utilization, documentation fails to support original authorization, patient condition changes, plan term changes, or specific payment/eligibility issues.

Requires dental service contractors to issue prior authorizations within 30 days of request and prohibits requiring additional information for prior authorization requests beyond what would be required for claim submission.

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

Takes effect July 1, 2019.