If a health care insurer exercises recoupment, then the health care insurer shall provide the health care provider written documentation that specifies the:
(1) Amount of the recoupment;
(2) Covered person's name to whom the recoupment applies;
(3) Patient identification number;
(4) Date or dates of service;
(5) Service or services on which the recoupment is based;
(6) Pending claims being recouped or future claims that will be recouped; and
(7) Specific reason for the recoupment.