North Dakota Code 26.1-47-02.3 – Postpayment of dental claims – Payment recovery limitations
1. As used in this section, “dental care provider” means a licensed provider of dental care services in this state.
Terms Used In North Dakota Code 26.1-47-02.3
- Fraud: Intentional deception resulting in injury to another.
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See North Dakota Code 1-01-49
- written: include "typewriting" and "typewritten" and "printing" and "printed" except in the case of signatures and when the words are used by way of contrast to typewriting and printing. See North Dakota Code 1-01-37
2. Other than recovery for duplicate payments, a dental insurer, if engaging in overpayment recovery efforts, shall provide written notice to the dental care provider which identifies the error made in the processing or payment of the claim and justifies the overpayment recovery.
3. A dental insurer shall provide a dental care provider with the opportunity to challenge an overpayment recovery, including the sharing of claims information, and shall establish written policies and procedures for a dental care provider to follow to challenge an overpayment recovery.
4. A dental insurer may not initiate overpayment recovery efforts more than twelve months after the original payment for the claim was made. This time limit does not apply to overpayment recovery efforts that are:
a. Based on reasonable belief of fraud, abuse, or other intentional misconduct; b. Required by, or initiated at the request of, a self-insured plan; or c. Required by a state or federal government plan.