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§1912. Standardized claim forms |
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| | | On or after December 1, 1993, all All administrators who | | administer claims and who provide payment or reimbursement for | | diagnosis or treatment of a condition or a complaint by a | | licensed physician or chiropractor must accept the current | | standardized claim form for professional services approved by the | Federal Government. On or after December 1, 1993, all All | | administrators who administer claims and who provide payment or | | reimbursement for diagnosis or treatment of a condition or a | | complaint by a licensed hospital must accept the current | | standardized claim form for professional or facility services, as | | applicable, approved by the Federal Government. An administrator | | may not be required to accept a claim submitted on a form other | | than the applicable form specified in this section. |
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| | | Sec. 3. 24-A MRSA §2436, sub-§2-A, as enacted by PL 2001, c. 569, §1, | | is amended to read: |
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| | | 2-A. For Except as provided in this subsection, for purposes | | of this section, an "undisputed claim" means a timely claim for | | payment of covered health care expenses under a policy or | | certificate providing health care coverage that is submitted to | | an insurer on the insurer's standard claim form using the most | | current published procedural codes with all the required fields | | completed with correct and complete information in accordance | | with the insurer's published claims filing requirements. After | | January 1, 2005, for a provider with 10 or more full-time- | | equivalent employees, an "undisputed claim" means a timely claim | | for payment of covered health care expenses under a policy or | | certificate providing health care coverage that is submitted to | | an insurer in the insurer's standard electronic data format using | | the most current published procedural codes with all the required | | fields completed with correct and complete information in | | accordance with the insurer's published claims filing | | requirements. This subsection applies only to a policy or | | certificate of a health plan as defined in section 4301-A, | | subsection 7. |
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| | | Sec. 4. 24-A MRSA §2436, sub-§3, as amended by PL 1999, c. 256, Pt. I, | | §1, is further amended to read: |
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| | | 3. If an insurer fails to pay an undisputed claim or any | | undisputed part of the claim when due, the amount of the overdue | | claim or part of the claim bears interest at the rate of 1 1/2% | | per month after the due date. Notwithstanding this subsection, |
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| | | the superintendent may adopt rules that establish a minimum | | amount of interest payable on an overdue undisputed claim to a | | health care provider before a payment must be issued.__Rules |
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