House Bill 1297

(As Passed the House)

AN ACT TO AMEND SECTION 83-41-219, MISSISSIPPI CODE OF 1972, TO REVISE THE RECIPROCAL TIME LIMITATIONS FOR AUDITS OF CLAIMS MADE BY THE DIVISION OF MEDICAID; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. Section 83-41-219, Mississippi Code of 1972, is amended as follows:

83-41-219. (1) If any health insurance issuer or other health insurance benefit payer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer shall have the same time limit following payment of the claim to perform any review or audit for reconsidering the validity of the claim and requesting reimbursement for payment of an invalid claim or overpayment of a claim.

(2) If any health insurance issuer or other health insurance benefit payer does not limit the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer or other health insurance benefit payer may not request reimbursement or offset another claim payment for reimbursement of an invalid claim or overpayment of a claim more than twelve (12) months after the payment of an invalid or overpaid claim.

(3) Nothing in this section shall apply to claims submitted in the context of misrepresentation, omission, concealment, or fraud by the health care provider or other person.

(4) Nothing in this section shall apply to an audit of a pharmacy as provided in Section 73-21-175 et seq., nor to claims submitted by providers for reimbursement under the Mississippi Medicaid Program, except that all audits of claims and payments made by or on behalf of the Division of Medicaid are limited to a maximum of five (5) years after payment of the claim. Auditors must be qualified and licensed to perform audits and must abide by the Financial Accounting Standards Board's Generally Accepted Accounting Principles and the American Institute of Certified Public Accountant's Generally Accepted Auditing Standards.

SECTION 2. This act shall take effect and be in force from and after July 1, 2012.