Section 3804 - Exceptions to retroactive denial of reimbursementThe provisions of section 3703 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply:
(1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter.(2) The claim submitted to the insurer was a duplicate claim.(3) Denial was required by a Federal or State government plan.(4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.Added by P.L. TBD 2016 No. 146, § 1, eff. 1/3/2017.