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Senate Finance sets $25,000 threshold for high‑dollar prepayment reviews and orders reporting for health‑care‑sharing plans
Summary
H.585 defines 'high‑dollar claims' as claims exceeding $25,000 per episode for purposes of prepayment validation and adds an annual reporting regime for non‑insurer health‑care‑sharing arrangements with penalties and public reporting requirements.
The committee also reviewed narrower technical changes in H.585: a concrete threshold for high‑dollar prepayment reviews and a new annual reporting requirement for health‑care‑sharing plans.
Joe Valente (DFR) told the committee Section 6 replaces the previously undefined term "high dollar" with a clear threshold: claims exceeding $25,000 per episode may be subject to prepayment coding validation review. This change clarifies when insurers may, but are not required to, seek…
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