| Be it enacted by the People of the State of Maine as follows: |
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| | Sec. 1. 24 MRSA §2333 is enacted to read: |
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| §2333.__Reimbursement of health insurance claims |
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| | 1.__Definitions.__As used in this section, unless the context | otherwise indicates, the following terms have the following | meanings. |
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| A.__"Clean health insurance claim" includes, but is not | limited to, a claim that is submitted on an insurer's | standard claim form and does not require additional | information for processing. |
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| B.__"Health insurance carrier" means a nonprofit hospital | and medical service organization licensed pursuant to this | Title; an insurance company licensed pursuant to Title 24-A; | a health maintenance organization regulated under Title 24- | A, chapter 56; a preferred provider organization regulated | pursuant to Title 24-A, chapter 32; a multiple-employer | welfare arrangement regulated pursuant to Title 24-A, | chapter 81; or a 3rd-party administrator of health benefit | plans licensed pursuant to Title 24-A, chapter 18. |
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| | 2.__Timely reimbursement required.__A health insurance carrier | shall reimburse any insured or medical care provider for a clean | health insurance claim within 14 days of claim submission when | the claim is filed electronically and within 30 days when the | claim is submitted on paper. |
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| A.__A health insurance carrier that does not reimburse a | claim within the appropriate time limit shall pay 1 1/2% | interest per month, accruing from the day after payment was | due on the amount of the claim that remains unpaid. |
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| B.__Where there is a good faith dispute regarding the | legitimacy of a claim or the appropriate amount of | reimbursement, notice that a dispute exists and the basis | for that dispute must be furnished by the health insurance | carrier to the insured or medical care provider upon receipt | of the claim and that notice suspends the time limit | established in this subsection for a 30-day period. |
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| | 3.__Penalty.__If the superintendent finds, after notice and | hearing, that a health insurance carrier has violated this | section, the superintendent may impose a civil penalty against | the health insurance carrier of no more than $500 per day for | each day a claim remains unpaid, with a maximum penalty for each |
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