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|Ohio's prompt pay law requires third-party payers to:|
- Inform providers about supporting medical documentation that is routinely required for a particular service. A description of the supporting documentation must be available to providers in a readily accessible format. (ORC Section 3901.38 B (2) (d))
- Establish a claim status check system by which providers and beneficiaries may determine the status of a particular claim. (ORC Section 3901.387 (B))
- Automatically pay interest on claims that are not paid in accordance with the time frames in Ohio's prompt pay law. The interest rate is eighteen per cent annually.
- Provide requests for supporting documentation in writing if requested.
Adjustments of Previously Paid Claims
Claim payments that are made on or after July 24, 2002, are deemed final two years after the payment is made. After that date, the amount of the payment is not subject to adjustment, except in the case of fraud by the provider.
A third-party payer may recover the amount of any part of a payment that the third-party payer determines to be an overpayment if the recovery process is initiated not later than two years after the payment was made to the provider.
Upon determination of an overpayment a third-party payer shall send a notice to the provider that contains the following:
- The full name of the beneficiary who received the health care services for which overpayment was made;
- The date or dates the services were provided;
- The amount of the overpayment;
- The claim number or other pertinent numbers;
- A detailed explanation of basis for the third-party payer's determination of overpayment;
- The method in which payment was made, including, for tracking purposes, the date of payment and, if applicable, the check number;
- That the provider may appeal the third-party payer's determination of overpayment, if the provider responds to the notice within thirty (30) days;
- The method by which recovery of the overpayment would be made, if recovery proceeds under division (B) of this section.