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. (HOD, 0413)