How far back can an insurer claw back?

Alabama

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

12 months (or the contract's claim-filing period if shorter)

Counted from

initial claim payment

Exceptions

fraud; coordination of benefits (18 months); duplicate payments

Statute

Ala. Code § 27-1-17(e)-(g)

Also

notice must give the reason; adjustments for medical necessity, level of service or coding must be reconciled to specific claims; provider may dispute within 30 days and then has 6 months to file a revised claim; FindLaw current as of 2024-12-30

Alaska

Not checked yet: from a November 2025 survey of state laws

Limit

365 days

Counted from

original payment

Exceptions

fraud or other intentional misconduct (clear and documented reason)

Statute

3 AAC 26.110

Also

regulation

Arizona

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

1 year

Counted from

insurer paid or denied the claim

Exceptions

fraud

Statute

A.R.S. § 20-3102(J)

Also

same period applies to provider adjustments; contract may set an equal period for both

Arkansas

Sources disagree; not resolved yet (source, 2026-10-17)

Limit

unresolved (survey: 18 months; FindLaw page: 120-day notice for verification errors)

Counted from

insurer paid the claim

Exceptions

fraud by the provider

Statute

Ark. Code § 23-63-1803

Also

written notice of intent to recoup required; recheck on arkleg.state.ar.us

California

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

365 days (written request)

Counted from

date of payment

Exceptions

fraud or misrepresentation by the provider

Statute

Cal. Ins. Code § 10133.66(b)

Also

notice must identify claim, patient, date of service and the reason; covers health insurers under the Insurance Code; Knox-Keene plans (most HMOs, Blue Shield) have their own rule, not checked; FindLaw current as of 2026-01-01

Colorado

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

12 months (contract may set less)

Counted from

original explanation of benefits

Exceptions

carrier reported provider fraud or abuse; risk-sharing reconciliation; COB with federal plans (36 months from service)

Statute

C.R.S. § 10-16-704(4.5)

Also

applies to contracted (ceiling) and non-contracted providers; FindLaw current as of 2025-01-01

Connecticut

From a secondary source; statute text not checked yet (source, 2026-10-17)

Limit

18 months (administrative or eligibility error)

Counted from

receipt of a clean claim

Exceptions

fraud; billing not supported by documentation; duplicate payment; government program; COB

Statute

Conn. Gen. Stat. § 38a-479b

Changing

12 months from 2027-01-01 (PA 26-56; also extends to other insurers)

Also

limit covers administrative/eligibility errors only; 'did not bill appropriately based on the documentation' is an exception, which is what a note audit alleges

Delaware

Not checked yet: from a November 2025 survey of state laws

Limit

12 months

Counted from

original payment

Exceptions

none stated in the text we read

Statute

18 Del. C. § 2730

Also

initiated = first audit report or similar communication

District of Columbia

Not checked yet: from a November 2025 survey of state laws

Limit

6 months (18 for coordination of benefits)

Counted from

insurer paid the provider

Exceptions

none stated in the text we read

Statute

D.C. Code § 31-3133

Florida

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

30 months

Counted from

insurer's payment of the claim

Exceptions

providers convicted of fraud (s. 817.234)

Statute

Fla. Stat. § 627.6131(6)

Also

provider must pay, deny or contest within 40 days; written notice within 35 days if contesting; 2025 statutes

Georgia

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

sooner of 18 months after submission or 24 months after service

Counted from

claimant's initial submission / date of service

Exceptions

precertified claims generally can't be reopened

Statute

O.C.G.A. § 33-20A-62(b)

Also

prior written notice naming the claim and reason, no later than 12 months after first submission; FindLaw current as of 2024-03-28

Hawaii

Not checked yet: from a November 2025 survey of state laws

Limit

18 months (72 for fraud or material misrepresentation)

Counted from

initial claim payment received

Exceptions

self-insured employer groups; national networks; federal programs; COB

Statute

HRS § 431:13-108

Idaho

No limit found yet; not researched

Illinois

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

12 months

Counted from

original payment

Exceptions

formal finding of fraud or material misrepresentation by a court, agency, tribunal or arbitrator; CHIP administration; paid in full by another payer; federal Medicaid requirement

Statute

215 ILCS 5/368d(c)

Also

contracts can't override it; the last sentence of (c) still says '18-month', operative text says 12; FindLaw current as of 2025-01-01

Indiana

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

2 years

Counted from

overpayment made

Exceptions

fraud by the provider, the insured or the insurer

Statute

Ind. Code § 27-8-5.7-10

Also

FindLaw current as of 2026-01-01

Iowa

Not checked yet: from a November 2025 survey of state laws

Limit

2 years (audit)

Counted from

submission of the claim

Exceptions

reasonable basis to suspect fraud

Statute

191 IAC 15.33

Also

limits audits; records requests still allowed

Kansas

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

18 months

Counted from

end of the month of the erroneous payment

Exceptions

fraud (general statute of limitations applies)

Statute

K.S.A. 40-2442(f)

Also

FindLaw current as of 2025-01-01

Kentucky

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

24 months

Counted from

insurer paid the claim

Exceptions

fraud

Statute

KRS § 304.17A-708

Also

written or electronic statement of the basis required; FindLaw current as of 2025-01-01

Louisiana

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

18 months

Counted from

initial claim paid

Exceptions

Office of Group Benefits (state employees) not covered

Statute

La. R.S. 22:1838(F)

Also

services rendered in good faith; FindLaw current as of 2023-01-01

Maine

No limit found yet; not researched

Maryland

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

6 months (18 for coordination of benefits)

Counted from

carrier paid the provider

Exceptions

fraud; improperly coded (if coding guidelines were given 30+ days before the service); duplicates; Medicaid capitation withdrawal

Statute

Md. Ins. Code § 15-1008(c),(e)

Also

written statement of the basis required; 'improperly coded' exception matters for 90837 audits; FindLaw current as of 2025-01-01

Massachusetts

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

12 months (behavioral health claims)

Counted from

provider submitted the claim

Exceptions

fraud; legal action; already paid; services not delivered

Statute

Ch. 41 of the Acts of 2019 (c. 175 § 108; c. 176A § 8A¾; c. 176B § 7D; c. 176G § 6B)

Also

within 12 months: written reason and 30 days to respond; not self-insured, Medicare or federal plans

Michigan

No limit found yet; not researched

Minnesota

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

12 months (required contract term)

Counted from

clean claim paid

Exceptions

coordination of benefits; subrogation; duplicate claims; retroactive terminations; fraud and abuse

Statute

Minn. Stat. § 62Q.75 subd. 4

Also

since 2010; SF 3214 (2025–26) would change it, status unknown

Mississippi

No limit found yet; not researched

Missouri

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

12 months

Counted from

health carrier paid the claim

Exceptions

fraud or misrepresentation

Statute

RSMo § 376.384.1(3)

Also

FindLaw current as of 2025-01-01

Montana

Not checked yet: from a November 2025 survey of state laws

Limit

12 months (if the issuer sets no claim-filing deadline)

Counted from

payment

Exceptions

none stated in the text we read

Statute

MCA § 33-22-150

Nebraska

Not checked yet: from a November 2025 survey of state laws

Limit

6 months (notice)

Counted from

date of the error

Exceptions

none stated in the text we read

Statute

210 NAC ch. 60 § 011

Also

regulation

Nevada

No limit found yet; not researched

New Hampshire

Not checked yet: from a November 2025 survey of state laws

Limit

12 months

Counted from

date of payment

Exceptions

none stated in the text we read

Statute

RSA 420-J:8-b

Also

written reason required

New Jersey

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

18 months

Counted from

first payment on the claim

Exceptions

fraud; pattern of inappropriate billing; COB

Statute

N.J. Stat. § 17B:27-44.2(d)(10)

Also

no collection before the 45th day after the request or while a timely appeal is pending; FindLaw current as of 2024-01-01 and flags a version effective 2025-01-01, so recheck

New Mexico

No limit found yet; not researched

New York

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

24 months

Counted from

original payment received by the provider

Exceptions

reasonable belief of fraud, intentional misconduct or abusive billing; self-insured plans; government programs and public-employee coverage

Statute

N.Y. Ins. Law § 3224-b(b)

Changing

A3365 (2025) would cut to 12 months, status unknown

Also

30 days' written notice before recovery (except duplicates); text revised 2014-09-22

North Carolina

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

2 years

Counted from

original claim payment

Exceptions

reasonable belief of fraud or other intentional misconduct; same service paid by a government payor

Statute

N.C. Gen. Stat. § 58-3-225(h)

Also

30 calendar days' written notice identifying the claim and reason; FindLaw copy current as of 2023-01-01 (ncleg.gov blocks automated access)

North Dakota

No limit found yet; not researched

Ohio

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

2 years

Counted from

payment made to the provider

Exceptions

none stated in the text we read

Statute

Ohio Rev. Code § 3901.388(B)

Changing

SB 162 (2025–26) would cut to 1 year, status to confirm

Also

written notice with claim details; provider may appeal within 30 days; FindLaw current as of 2026-01-01 (codes.ohio.gov unreachable from here)

Oklahoma

Not checked yet: from a November 2025 survey of state laws

Limit

18 months

Counted from

payment made

Exceptions

fraud; provider agreed to refund

Statute

36 Okla. Stat. § 1250.5

Oregon

No limit found yet; not researched

Changing

HB 4028 (2026): behavioral-health audit rules incl. no recoupment for clerical errors; passed House 41-1, Senate outcome not found

Pennsylvania

From a secondary source; statute text not checked yet (source, 2026-10-17)

Limit

no statutory limit

Exceptions

none stated in the text we read

Statute

none found

Changing

Sen. Argall bill for a 12-month limit (status unknown)

Also

contract terms govern

Rhode Island

No limit found yet; not researched

South Carolina

Not checked yet: from a November 2025 survey of state laws

Limit

18 months

Counted from

initial payment received

Exceptions

fraud or intentional misconduct; self-insured plans; government programs

Statute

S.C. Code § 38-59-250

South Dakota

No limit found yet; not researched

Tennessee

Sources disagree; not resolved yet (source, 2026-10-17)

Limit

unresolved: 15 months (18 for state employee plans) in FindLaw's copy; the 2025 survey quotes 18 months

Counted from

entity paid the claim

Exceptions

fraud or suspected fraud by the provider; tolling by agreement

Statute

Tenn. Code § 56-7-110(c)

Also

FindLaw current as of 2024-01-02; the survey may reflect a later amendment; recheck the official code

Texas

Checked against FindLaw's copy of the statute (source, 2026-10-17)

Limit

written notice within 180 days

Counted from

provider receives the payment

Exceptions

none stated in the text we read

Statute

Tex. Ins. Code § 1301.132

Also

PPO plans (ch. 1301); provider may arrange repayment within 45 days or appeal, and no recovery until appeal rights are exhausted; HMOs under ch. 843 not checked; FindLaw current as of 2026-01-01

Utah

Not checked yet: from a November 2025 survey of state laws

Limit

12 months (24 for COB; 36 for Medicaid/Medicare recovery)

Counted from

amount improperly paid

Exceptions

none stated in the text we read

Statute

Utah Code § 31A-26-301.6(14)

Vermont

Not checked yet: from a November 2025 survey of state laws

Limit

12 months

Counted from

date of payment

Exceptions

fraud or intentional misconduct; already paid; services not delivered; COB; legal action

Statute

18 V.S.A. § 9418

Virginia

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

12 months

Counted from

payment of the original claim

Exceptions

fraud; already paid; services not delivered

Statute

Va. Code § 38.2-3407.15(B)(8)

Also

30 days' notice; contract may allow offset later

Washington

Checked against the statute on the state's official site (source, 2026-10-17)

Limit

24 months

Counted from

payment made

Exceptions

fraud

Statute

RCW 48.43.600(1)

Changing

6 months for mental health and SUD services from 2027-01-01 (2025 c 227)

Also

provider must contest in writing within 30 days or the request is deemed accepted

West Virginia

Not checked yet: from a November 2025 survey of state laws

Limit

1 year (some reasons: no limit)

Counted from

date originally paid

Exceptions

none stated in the text we read

Statute

W. Va. Code § 33-45-2

Wisconsin

No limit found yet; not researched

Wyoming

Not checked yet: from a November 2025 survey of state laws

Limit

2 years

Counted from

claim paid

Exceptions

fraud

Statute

Wyo. Stat. § 26-15-137