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23-63-1803. Persons not covered.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-63-1803. Persons not covered.
(a) If a health care insurer determines that payment was made for services not covered under the covered person's health insurance coverage, the health care insurer shall give written notice to the health care provider of its intent to exercise recoupment and may:
(1) Request a refund from the health care provider; or
(2) Make a recoupment of the payment from the health care provider in accordance with § 23-63-1804.
(b)(1) Except in the case of fraud committed by the health care provider or as provided in subdivision (b)(2) of this section, subsection (a) of this section shall not apply if a health care provider or other party on its behalf verified from the health care insurer or its agent that an individual was a covered person and if the health care provider in good faith provided services to the individual in reliance on the verification.
(2) A health care insurer has one hundred twenty (120) days from the date of payment to notify the provider of a verification error and the fact that services rendered will not be covered if the error was made in good faith at the time of the verification.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-63-1803
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Record provenance
Stable record: arkansas_code:legal_authorities:23-63-1803
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: a15b4d02c0a44c13d698386bb9009c743c5a405f5d9f6acc7ea3c7dae63fe623
Source location: content.xml paragraph 34533
Stored source content
23-63-1803. Persons not covered.
(a) If a health care insurer determines that payment was made for services not covered under the covered person's health insurance coverage, the health care insurer shall give written notice to the health care provider of its intent to exercise recoupment and may:
(1) Request a refund from the health care provider; or
(2) Make a recoupment of the payment from the health care provider in accordance with § 23-63-1804.
(b)(1) Except in the case of fraud committed by the health care provider or as provided in subdivision (b)(2) of this section, subsection (a) of this section shall not apply if a health care provider or other party on its behalf verified from the health care insurer or its agent that an individual was a covered person and if the health care provider in good faith provided services to the individual in reliance on the verification.
(2) A health care insurer has one hundred twenty (120) days from the date of payment to notify the provider of a verification error and the fact that services rendered will not be covered if the error was made in good faith at the time of the verification.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-63-1804. Recoupments — Required disclosures.
If a health care insurer exercises recoupment, then the health care insurer shall provide the health care provider written documentation that specifies the:
(1) Amount of the recoupment;
(2) Covered person's name to whom the recoupment applies;
(3) Patient identification number;
(4) Date or dates of service;
(5) Service or services on which the recoupment is based;
(6) Pending claims being recouped or future claims that will be recouped; and
(7) Specific reason for the recoupment.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-63-1804
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-63-1804. This identifies an authority to review, not proof of applicability.