MS SB2833

Requires dental service contractors to establish appeal procedures for claims denied based on lack of medical necessity, with subsequent appeals reviewed by a qualified dentist separate from the one who made the initial denial.

Mandates that any written denial of benefits include the reviewing dentist's name, specialty designation, license number, state of issuance, and email address.

Defines "prior authorization" as formal, verifiable authorization (by letter, facsimile, email, or similar means) indicating specific procedures are covered and reimbursable at a set amount, and prohibits denial of authorized claims except under five specified circumstances (benefit limitations reached, documentation fails to support claim, patient's condition changed, coverage terms require disapproval, or other payor responsible).

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 needed for claim submission.

Prohibits contractors from recouping claims solely due to patient ineligibility if the contractor erroneously confirmed coverage despite having information indicating the patient was no longer covered.

Effective July 1, 2020.