Ohio § 3901.384

§ 3901.384.

(A) Subject to division (B) of this section, a third-party payer that requires timely

submission of claims for payment for health care services shall process a claim that

is not submitted in a timely manner if a claim for the same services was initially

submitted to a different third-party payer or state or federal program that offers

health care benefits and that payer or program has determined that it is not responsible

for the cost of the health care services.  When a claim is submitted later than one year after the last date of service for

which reimbursement is sought under the claim, the third-party payer shall pay or

deny the claim not later than ninety days after receipt of the claim or, alternatively,

pursuant to the requirements of sections 3901.381 to 3901.388 of the Revised Code .  The third-party payer must make an election to process such claims either within

the ninety-day period or under section 3901.381 of the Revised Code .  If the claim is denied, the third-party payer shall notify the provider and the

beneficiary.  The notice shall state, with specificity, why the third-party payer denied the claim. (B) The third-party payer may refuse to process a claim submitted by a provider if the

provider submits the claim later than forty-five days after receiving notice from

the different third-party payer or a state or federal program that that payer or program

is not responsible for the cost of the health care services, or if the provider does

not submit the notice of denial from the different third-party payer or program with

the claim.  The failure of a provider to submit a notice of denial in accordance with this division

shall not affect the terms of a benefits contract. (C) For purposes of this section, both of the following apply: (1) A determination that a third-party payer or state or federal program is not responsible

for the cost of health care services includes a determination regarding coordination

of benefits, preexisting health conditions, ineligibility for coverage at the time

services were provided, subrogation provisions, and similar findings; (2) State and federal programs that offer health care benefits include medicare, medicaid,

workers' compensation, the civilian health and medical program of the uniformed services

and other elements of the tricare program offered by the United States department

of defense, and similar state or federal programs. (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.