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The Committee on Health Policy (Dockery) recommended the

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following substitute for amendment (457874):

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     Senate Amendment (with title amendment)

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     Between line(s) 33 and 34,

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insert:

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     Section 1.  Subsections (3) and (6) of section 627.6131,

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Florida Statutes, are amended to read:

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     627.6131  Payment of claims.--

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     (3) All claims for payment, underpayment, or overpayment,

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whether electronic or nonelectronic:

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     (a)  Are considered received on the date the claim is

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received by the insurer at its designated claims-receipt location

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or the date the claim for overpayment is received by the provider

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at its designated location.

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     (b)  Must be mailed or electronically transferred to the

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primary insurer within 60 days 6 months after the following have

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occurred:

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     1.  Discharge for inpatient services or the date of service

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for outpatient services; and

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     2.  The provider has been furnished with the correct name

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and address of the patient's health insurer.

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All claims for payment, whether electronic or nonelectronic, must

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be mailed or electronically transferred to the secondary insurer

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within 90 days after final determination by the primary insurer.

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A provider's claim is considered submitted on the date it is

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electronically transferred or mailed.

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     (c)  Must not duplicate a claim previously submitted unless

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it is determined that the original claim was not received or is

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otherwise lost.

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     (6)  If a health insurer determines that it has made an

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overpayment to a provider for services rendered to an insured,

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the health insurer must make a claim for such overpayment to the

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provider's designated location. A health insurer that makes a

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claim for overpayment to a provider under this section shall give

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the provider a written or electronic statement specifying the

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basis for the retroactive denial or payment adjustment. The

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insurer must identify the claim or claims, or overpayment claim

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portion thereof, for which a claim for overpayment is submitted.

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     (a)  If an overpayment determination is the result of

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retroactive review or audit of coverage decisions or payment

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levels not related to fraud, a health insurer shall adhere to the

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following procedures:

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     1.  All claims for overpayment must be submitted to a

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provider within 18 30 months after the health insurer's payment

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of the claim. A provider must pay, deny, or contest the health

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insurer's claim for overpayment within 40 days after the receipt

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of the claim. All contested claims for overpayment must be paid

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or denied within 120 days after receipt of the claim. Failure to

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pay or deny overpayment and claim within 140 days after receipt

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creates an uncontestable obligation to pay the claim.

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     2.  A provider that denies or contests a health insurer's

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claim for overpayment or any portion of a claim shall notify the

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health insurer, in writing, within 35 days after the provider

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receives the claim that the claim for overpayment is contested or

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denied. The notice that the claim for overpayment is denied or

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contested must identify the contested portion of the claim and

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the specific reason for contesting or denying the claim and, if

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contested, must include a request for additional information. If

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the health insurer submits additional information, the health

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insurer must, within 35 days after receipt of the request, mail

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or electronically transfer the information to the provider. The

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provider shall pay or deny the claim for overpayment within 45

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days after receipt of the information. The notice is considered

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made on the date the notice is mailed or electronically

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transferred by the provider.

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     3.  The health insurer may not reduce payment to the

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provider for other services unless the provider agrees to the

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reduction in writing or fails to respond to the health insurer's

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overpayment claim as required by this paragraph.

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     4.  Payment of an overpayment claim is considered made on

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the date the payment was mailed or electronically transferred. An

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overdue payment of a claim bears simple interest at the rate of

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12 percent per year. Interest on an overdue payment for a claim

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for an overpayment begins to accrue when the claim should have

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been paid, denied, or contested.

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     (b) A claim for an underpayment by a provider or

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overpayment by a health insurer may shall not be made permitted

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beyond 18 30 months after the health insurer's payment of a

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claim, except that claims for overpayment may be sought beyond

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that time from providers convicted of fraud pursuant to s.

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817.234 or where fraud or abuse is suspected.

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================ T I T L E  A M E N D M E N T ================

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And the title is amended as follows:

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     On line(s) 2, after the semicolon,

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insert:

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amending s. 627.6131, F.S.; reducing the period for a

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health insurer to submit a claim to a provider for

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underpayment or overpayment; reducing the amount of time

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in which a claim for an underpayment by a provider or

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overpayment by a health insurer is permitted; providing an

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exception;

4/1/2008  11:51:00 AM     15-06301A-08