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Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.
According to the Legislative Budget Board, no fiscal impact to the state is anticipated.
HB 2151 would amend the Insurance Code to prohibit a health maintenance organization or insurer from using extrapolation, an estimate of audit results for a large group of claims not reviewed by the insurance organization, to complete an audit of participating physicians or providers. Any additional payment due to a physician or provider or any refund due to the health maintenance organization or insurer must be based on actual overpayment or underpayment and may not be based on extrapolation.