HCS HB 1498 -- PAYMENT OF HEALTH INSURANCE CLAIMS

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 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 carrier 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 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 provider to pay the claim, deny all or part
of the claim specifying the reason, or make a final request for
additional information.  If the provider submits the additional
information, the carrier must pay or deny the claim within five
processing days, instead of the current 15 days, of receiving the
additional information;

(4)  Requires a carrier to pay a penalty equal to 1% of the total
claim amount per day on unpaid claims if it has not paid a
claimant within 45 processing days of receiving the claim;

(5)  Allows a carrier to combine interest payments on unpaid
claims and make payment when the total amount reaches $100
instead of the current $5.  A claim that was 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 the required action within 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 or all of a claim on a
multi-claim form.

The bill becomes effective January 1, 2011.

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