HB 1154 Summary

• Dental benefit plans cannot deny claims for prior-authorized procedures unless specific circumstances apply, including benefit limits reached after authorization, inadequate documentation, changes in patient condition, or eligibility issues.

• Contracting entities may grant third parties access to dental provider networks only if the contract explicitly permits it, providers are notified 30 days in advance, and dental providers retain the right to opt out at contract renewal.

• Dental insurers seeking overpayment recovery must provide written notice identifying the processing error and justifying the recovery, and must allow providers to challenge the recovery with access to claims information.

• Dental insurers cannot initiate overpayment recovery efforts more than twelve months after original payment, except for cases involving suspected fraud, self-insured plan requirements, or government plan requirements.