(1) Terms defined in Section 31A-26-301.7 apply to this section.
(2) An insurer may not require a dental provider to submit the dental provider's full fee-for-service charges on a claim form as a condition of payment or processing if:
(a) the dental provider disclosed the dental provider's full fee schedule during credentialing, contract negotiation, or renewal; and
(b) the contract includes a contracted fee schedule for covered services.
(3)
(a) If an insurer requires submission of a claim form, a dental provider may report:
(i) the contracted fee; or
(ii) the dental provider's fee for service.
(b) An insurer may not penalize a dental provider because of the dental provider's choice under Subsection (3)(a).
(4) If an insurer determines that a provided dental service is not a covered service, the insurer shall issue an explanation of benefits to the dental provider and patient that:
(a) clearly states that the procedure code is not covered under the dental plan; and
(b) does not describe the unreimbursed amount as a required contractual adjustment or mandatory write-off.
(5)
(a) An insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result.
(b) A dental provider who receives an overpayment from a dental plan shall return the amount of the overpayment through check or other means to the dental plan within 60 days from the day the insurer sends a notice of the overpayment.
(6) An insurer's failure to comply with Subsection (4) does not prevent a dental provider from billing and collecting payment from a patient for a non-covered service.