Health insurers must start recovering overpayments within one year

Health insurers must begin recovering overpayments within one year of paying the provider. The rules cover payments to health care providers under Ohio's cited health insurance payment laws. Payments become final after one year, except in cases of fraud by the provider. These rules take effect October 7, 2026; the one-year clock starts when the insurer pays the provider.

Insurers must let providers appeal an overpayment decision without charging an appeal fee. These protections cover providers receiving an insurer's notice that a payment was too large. An insurer may begin recovery if the provider misses the response deadline or an appeal is denied. These rules take effect October 7, 2026; the response deadline runs from the overpayment notice.

Insurers must give providers written overpayment notices and use an agreed electronic system when applicable. Notices must identify the payment, explain why the insurer believes it paid too much, and describe appeal and recovery options. If the insurer and provider use an agreed, established electronic notification system, the insurer must send the notice through that system. These notice rules take effect October 7, 2026.