Retroactive adjustment of health care service claims.

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(1) Twelve months or more after the date a claim is paid for health care services performed pursuant to this part 6, an insurer may not retroactively adjust the payment of the claim.

(2) Adjustments to claims made pursuant to a policy providing for medical payments coverage in cases where a carrier has reported fraud or abuse, pursuant to section 10-1-128 (5)(a)(IV), committed by the provider shall not be subject to the requirements of subsection (1) of this section.

Source: L. 2004: Entire section added, p. 530, § 1, effective January 1, 2005.


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