LD 2096
pg. 1
LD 2096 Title Page An Act Requiring Timely Reimbursement of Health Insurance Claims Page 2 of 3
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LR 2457
Item 1

 
Be it enacted by the People of the State of Maine as follows:

 
Sec. 1. 24 MRSA §2333 is enacted to read:

 
§2333.__Reimbursement of health insurance claims

 
1.__Definitions.__As used in this section, unless the context
otherwise indicates, the following terms have the following
meanings.

 
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.

 
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.

 
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.

 
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.

 
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.

 
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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