The provisions of section 3803 (relating to retroactive denial of reimbursement) do not apply if an insurer retroactively denies reimbursement to a health care provider because any of the following apply: (1) The information submitted to the insurer constitutes fraud, waste or abuse as defined in this chapter. (2) The claim submitted to the insurer was a duplicate claim. (3) Denial was required by a Federal or State government plan. (4) Services were subject to coordination of benefits with another insurer, the medical assistance program or the Medicare program.
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