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INS-004: Retrospective Denials

Retrospective Denials: The Wisconsin Medical Society supports legislation that, except in cases of fraud:

  • Limits the look back period to six months after the claim is paid for supposed overpayments and payment errors made by insurers to physicians.
  • Prohibits deduction of supposed overpayments or payment errors from cur­rent claims.
  • Requires notification of the supposed overpayment or payment error in writ­ing along with an explanation and documentation of the supposed overpay­ment or payment error. (BOD, 0618)