HB 1971 -- Payment of Health Insurance Claims

Sponsor:  Bivins

This bill changes the laws regarding the payment of health
insurance claims.  In its main provisions, the bill:

(1)  Requires health insurance carriers, including third-party
contractors, to send an electronic acknowledgment of the date of
receipt within one working day after an electronically filed
health care claim is received;

(2)  Increases the period of time, from within 10 working days to
within 15 days, that a health insurance carrier or a third-party
contractor has to send an electronic notice of the status of a
health care claim that notifies the claimant whether the filed
claim has any reason which will prevent timely payment or if more
information is required.  If the claim is properly filed, the
carrier must pay or deny the claim;

(3)  Requires a health carrier to notify the health care
provider, electronically, within 15 days, upon receiving the
requested additional information from the health care provider to
pay the claim or make a final request for additional information.
If the health care provider submits the additional information,
the health carrier must pay or deny, but cannot suspend the claim
within 15 days of receiving the additional information;

(4)  Adds a penalty equal to one-fifth of the total claim amount
per day on unpaid claims if a carrier has not paid a claimant
within 45 processing days of receiving the claim;

(5)  Lowers the amount at which a carrier can combine interest
and payments on unpaid claims from $500 to $100.  Claims that
were properly denied prior to the forty-fifth processing day will
not be subject to interest or penalties;

(6)  Repeals the current penalty imposed on carriers that do not
take required action within the 40 processing days;

(7)  Specifies that a claim for which a carrier has not
communicated a specific reason for the denial of payment cannot
be considered denied; and

(8)  Changes the requirements a carrier must follow when
requesting the documentation and additional information that is
necessary to process all of a claim.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:12 pm