As Introduced
136th General Assembly
Regular Session S. B. No. 162
2025-2026
Senator Blessing
To amend section 3901.388 of the Revised Code
regarding the timeframe for health insurer
recoupment from health care providers.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That section 3901.388 of the Revised Code be
amended to read as follows:
Sec. 3901.388. (A)(A)(1) A payment made by a third-party
payer to a provider in accordance with sections 3901.381 to
3901.386 of the Revised Code shall be considered final two years
after upon the conclusion of a time period, beginning on the
date payment is made and ending on the date that occurs after
the same number of days the health plan issuer grants for the
filing of provider claims . After that date, the amount of the
payment is not subject to adjustment, except in the case of
fraud by the provider.
(2) No third-party payer shall change its payment, audit,
or review timelines during the contract period.
(B) A third-party payer may recover the amount of any part
of a payment that the third-party payer determines to be an
overpayment if the recovery process is initiated not later than
two years after the payment was made to the provider within the
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20 S. B. No. 162 Page 2
As Introduced
period of time described in division (A)(1) of this section . The
third-party payer shall inform the provider of its determination
of overpayment by providing notice in accordance with division
(C) of this section. The third-party payer shall give the
provider an opportunity to appeal the determination and shall
not charge the provider a fee for an appeal . If the provider
fails to respond to the notice sooner than thirty days after the
notice is made, elects not to appeal the determination, or
appeals the determination but the appeal is not upheld, the
third-party payer may initiate recovery of the overpayment.
When a provider has failed to make a timely response to
the notice of the third-party payer's determination of
overpayment, the third-party payer may recover the overpayment
by deducting the amount of the overpayment from other payments
the third-party payer owes the provider or by taking action
pursuant to any other remedy available under the Revised Code.
When a provider elects not to appeal a determination of
overpayment or appeals the determination but the appeal is not
upheld, the third-party payer shall permit a provider to repay
the amount by making one or more direct payments to the third-
party payer or by having the amount deducted from other payments
the third-party payer owes the provider.
(C) The notice of overpayment a third-party payer is
required to give a provider under division (B) of this section
shall be made in writing and shall specify all of the following:
(1) The full name of the beneficiary who received the
health care services for which overpayment was made;
(2) The date or dates the services were provided;
(3) The amount of the overpayment;
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As Introduced
(4) The claim number or other pertinent numbers;
(5) A detailed explanation of basis for the third-party
payer's determination of overpayment;
(6) The method in which payment was made, including, for
tracking purposes, the date of payment and, if applicable, the
check number;
(7) That the provider may appeal the third-party payer's
determination of overpayment, if the provider responds to the
notice within thirty days;
(8) The method by which recovery of the overpayment would
be made, if recovery proceeds under division (B) of this
section.
(D) Any provision of a contractual arrangement entered
into between a third-party payer and a provider or beneficiary
that is contrary to divisions (A) to (C) of this section is
unenforceable.
Section 2. That existing section 3901.388 of the Revised
Code is hereby repealed.
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