An Act Concerning Return Of Health Care Provider Payments.
HB 5377, Public Act 26-56, limits when health insurers and other contracting health organizations may cancel, deny, or seek repayment of payments made for an authorized covered health care service because of administrative or eligibility errors. In general, the bill shortens the lookback period from 18 months to 12 months after receipt of a clean claim, while preserving exceptions for fraud, incorrect billing based on the services actually provided, duplicate payment, claims that should have been paid by a federal or state program, and situations involving coordination of benefits, subrogation, automobile insurance, or workers’ compensation.
The bill also requires at least 30 days’ advance notice before a repayment demand or denial takes effect, specifies what the notice must include, and gives providers a right to appeal through the payer’s procedures, including an electronic appeal process. If the payer does not decide the appeal within 30 business days, the appeal is deemed to favor the provider, and any repayment demand is stayed while the appeal is pending. The measure further allows providers to resubmit adjusted claims in some cases and gives them one year to identify and bill other applicable coverage, notwithstanding ordinary timely-filing limits.
The act amends existing insurance statutes governing contracting health organizations and creates parallel requirements for insurers, health care centers, fraternal benefit societies, hospital service corporations, medical service corporations, and other entities issuing individual or group health policies in Connecticut. It changes the repayment/recoupment timeline, notice requirements, appeal rights, and secondary-billing deadlines for health care provider claims, and it applies to policies and claims beginning January 1, 2027. The practical effect is to provide providers with greater certainty and more time before payments can be clawed back, while preserving payer rights in cases of fraud or other specified overpayments.
The voting record shows strong and unanimous support in committee, the House, and the Senate, with no recorded opposition in any of the listed votes. That pattern suggests broad bipartisan agreement that the bill addresses a fairness and administrative-process issue in provider payment recoupments. The absence of committee transcripts limits insight into debate, but the final votes indicate the measure was generally viewed favorably by lawmakers.
There is little evidence of major controversy in the available record, given the unanimous votes and lack of recorded dissent. The main policy tension inherent in the bill is between protecting health care providers from late recoupment demands and preserving insurers’ ability to recover improper payments. The bill resolves that tension by imposing a shorter deadline and stronger notice/appeal protections, while carving out exceptions for fraud, duplicate payments, incorrect billing, and other clearly identified overpayment scenarios.