NC S430

Insurers must provide written notice at least 30 calendar days before retroactively denying a previously paid claim, seeking overpayment recovery, or offsetting future payments, with specific information identifying the claim and reason.

Insurers may recover overpayments within six months after the original claim payment, except when fraud is suspected, the provider received duplicate payment from a government payor, coordination of benefits applies (18-month window), or the claim is a duplicate.

Health care providers may recover underpayments or nonpayments from insurers within six months after the original claim adjudication, except when the provider received payment for the same service from a government payor.

Recoveries of overpayments, underpayments, or nonpayments may include applicable interest as provided under existing law.

The act becomes effective October 1, 2019, and applies to claims submitted on or after that date.