1.1.................... moves to amend H.F. No. 1345, the first engrossment, as follows:
1.2Page 3, line 25, delete "type of care" and insert "covered service"
1.3Page 3, line 31, after "period" insert "for a provider"
1.4Page 3, line 32, delete "or statute" and insert "except when otherwise required by
1.5state or federal law or regulation"
1.6Page 3, line 34, after the period, insert "For purposes of this paragraph, presentation
1.7of the health coverage identification card by the patient is deemed sufficient notification of
1.8the correct information."
1.9Page 4, line 25, before "No" insert "Except as noted in this paragraph,"
1.10Page 4, line 28, after the period, insert
1.11"This paragraph does not apply to any audit conducted by the health plan company to
1.12determine whether:
1.13    (1) the service provided met clinical guidelines that were available to the provider
1.14prior to the provision of the service;
1.15    (2) the payment was an overpayment or otherwise made in error to the provider; or
1.16    (3) the payment made to the provider was correct based on coordination of benefits,
1.17subrogation, or other third-party liability payments made to the provider."
1.18Page 4, line 31, after the period, insert
1.19"A health plan company may withhold payment if there is:
1.20    (1) suspicion of fraudulent claims submissions by the provider;
1.21    (2) documentation that the provider has failed to provide services consistent with
1.22clinical guidelines; or
1.23    (3) suspicion of overpayments based on coding error or other coding irregularities."
1.24Page 4, line 32, after "investigation" insert a comma
1.25Page 4, line 33, delete "under sections 60A.951 to 60A.956 by" and insert "or abuse,
1.26by a health plan company or"
1.27Page 5, line 2, delete "before, on, or" and insert "for services provided"