1. (a) This section applies to a claim filed after December 31, 2018, for a medically necessary health care service rendered by a participating provider, the necessity of which:

   1. (1) is not anticipated at the time prior authorization is obtained for another health care service; and
   2. (2) is determined at the time the other health care service is rendered.
2. (b) The health plan shall not deny a claim described in subsection
3. (a) based solely on lack of prior authorization for the unanticipated health care service.
4. (c) The health plan:

5. (1) shall not deny payment for a health care service that is rendered in accordance with:

   1. (A) a prior authorization; and
   2. (B) all terms and conditions of the participating provider's agreement or contract with the health plan; and

6. (2) may:

   1. (A) require retrospective review of; and

   2. (B) withhold payment for;

      an unanticipated health care service described in subsection (a).

As added by P.L.77-2018, SEC.2.