HCS HB 1498 -- PAYMENT OF HEALTH INSURANCE CLAIMS (Jones, 89)

COMMITTEE OF ORIGIN:  Committee on Health Care Policy

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

(1)  Requires health insurance carriers, including third-party
contractors, to send an electronic acknowledgment of the date of
receipt within 48 hours after an electronically filed health care
claim is received;

(2)  Increases the period of time, from within 10 working days to
within 30 processing days, that a health insurance carrier or a
third-party contractor has to send an electronic or facsimile
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 or by fax, within 10 processing days,
instead of the current 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 the claim within five processing
days, instead of the current 15 days, of receiving the additional
information;

(4)  Adds a penalty equal to 1% 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)  Increases the amount at which a carrier can combine interest
and payments on unpaid claims from $5 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.

The substitute becomes effective January 1, 2011.

FISCAL NOTE:  Estimated Income on General Revenue Fund of Unknown
less than $30,579 in FY 2011, Unknown less than $36,710 in FY
2012, and Unknown less than $36,710 in FY 2013.  No impact on
Other State Funds in FY 2011, FY 2012, and FY 2013.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:11 pm