Relating to eligibility for mediation of certain out-of-network health benefit claims.

Contracts

• RCM/Billing Vendor Agreements: You must amend Master Services Agreements (MSAs) with third-party billing vendors.
• Mandate: Explicitly require the vendor to file mediation requests within the 180-day statutory window.
• Indemnification: Add clauses holding the vendor financially liable for the full claim amount if they negligently miss the filing deadline, as the right to recovery is permanently lost.

Hiring/Training

• Revenue Cycle Staff: Train staff to treat the "Initial Payment" or "Remittance Advice" date as a strict legal trigger, not just a billing event.
• Software Configuration: Configure practice management software to flag out-of-network claims that remain underpaid at the 150-day mark. This provides a 30-day buffer for legal review before the 180-day hard stop.

Reporting & Record-Keeping

• Proof of Receipt: You must maintain irrefutable evidence of *when* a payment or denial was received to defend against timeliness challenges.
• Electronic: Archive EFT transaction logs and 835 ERA files with timestamps.
• Paper: Implement a mandatory "Date Received" stamping protocol for physical checks and EOBs.

Fees & Costs

• Budget Impact: While there are no new state fees, the cost of non-compliance is total revenue forfeiture on disputed claims.
• Resource Allocation: Allocate budget for a Q3 2025 audit of aged Accounts Receivable to prepare for the "Legacy Cliff" filing.