altered — Contracted payment rate requirement and exceptions. A. A health benefit plan may not revoke, limit, condition, or restrict a prior authorization if care is provided within forty-five (45) business days from the date the health care provider received the prior authorization unless the enrollee was no longer eligible for care on the day care was provided. B. A health benefit plan must pay a contracted health care provider at the contracted payment rate for a health care service provided by the health care provider per a prior authorization, unless: 1. The health care provider knowingly and materially misrepresented the health care service in the prior authorization request with the specific intent to deceive and obtain an unlawful payment from a utilization review entity; 2. The health care service was no longer a covered benefit on the day it was provided; 3. The health care provider was no longer contracted with the patient's health benefit plan on the date the care was provided; 4. The health care provider failed to meet the utilization review entity's timely filing requirements; or 5. The patient was no longer eligible for health care coverage on the day the care was provided.
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