A BILL TO BE ENTITLED
AN ACT to increase payment stability for health care providers regarding payments from insurers offering health benefit plans.
The General Assembly of North Carolina enacts:
SECTION 1.(a)  Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read:
"§ 58‑3‑226.  Overpayment, retroactive denials, underpayments, and nonpayment; health benefit plans.
(a)	For the purposes of this section, the terms "health benefit plan," "health care facility," and "health care provider" shall have the same meaning as in G.S. 58‑3‑225."
SECTION 1.(b)  G.S. 58‑3‑225(h) is recodified as G.S. 58‑3‑226(b).
SECTION 2.  G.S. 58‑3‑226, as enacted by Section 1 of this act, reads as rewritten:
"§ 58‑3‑226.  Overpayment, underpayments, and nonpayment; health benefit plans.
(a)	For the purposes of this section, the terms "health benefit plan," "health care facility," and "health care provider" shall have the same meaning as in G.S. 58‑3‑225.
(b)	Subject to the time lines required under this subsection, an insurer may recover overpayments made to a health care provider or health care facility by making demands for refunds and by offsetting future payments. Any demands or payment offsets may also include related interest payments that were made under the requirements of G.S. 58‑2‑225. Not less than 30 calendar days before an insurer retroactively denies a previously paid claim, seeks overpayment recovery, or offsets future payments, the insurer shall give written notice to the health care provider or health care facility. The required notice shall be accompanied by adequate specific information to identify the specific claim and the specific reason for the denial or the recovery. The retroactive denial of a previously paid claim, the recovery of overpayments, or the offsetting of future payments under this subsection shall be made within the six months after the date of the original claim payment unless any of the following apply:
(1)	The insurer has reasonable belief of fraud or other intentional misconduct by the health care provider or health care facility or its agents.
(2)	The claim involves a health care provider or health care facility receiving payment for the same service from a government payor.
(3)	The claim was subject to coordination of benefits with another insurer. If the claim was subject to coordination of benefits with another insurer, then the time period is extended to 18 months.
(4)	The claim submitted was a duplicate claim.
(c)	A health care provider or health care facility may recover underpayments or nonpayments by the insurer by making demands for refunds. Any recoveries by the health care provider or health care facility of underpayments or nonpayment by the insurer may include applicable interest as provided under G.S. 58‑3‑225. The recovery of underpayments or nonpayments under this subsection shall be made within the six months after the date of the original claim adjudication, unless the claim involves a health provider or health care facility receiving payment for the same service from a government payor."
SECTION 3.  This act becomes effective October 1, 2019, and applies to claims submitted on or after that date.