SF 455

as introduced - 83rd Legislature (2003 - 2004) Posted on 12/15/2009 12:00am

  1.1                          A bill for an act 
  1.2             relating to health; modifying prompt payment 
  1.3             requirements; amending Minnesota Statutes 2002, 
  1.4             section 62Q.75, subdivision 2. 
  1.5   BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  1.6      Section 1.  Minnesota Statutes 2002, section 62Q.75, 
  1.7   subdivision 2, is amended to read: 
  1.8      Subd. 2.  [CLAIMS PAYMENTS.] (a) This section applies to 
  1.9   clean claims submitted to a health plan company or third-party 
  1.10  administrator for services provided by any: 
  1.11     (1) health care provider, except a provider licensed under 
  1.12  chapter 151; 
  1.13     (2) home health care provider, as defined in section 
  1.14  144A.43, subdivision 4; or 
  1.15     (3) health care facility. 
  1.16  All health plan companies and third-party administrators must 
  1.17  pay or deny claims that are clean claims within 30 calendar days 
  1.18  after the date upon which the health plan company or third-party 
  1.19  administrator received the claim. 
  1.20     (b) If a health plan company or third-party administrator 
  1.21  determines that a claim is not clean, the health plan company or 
  1.22  third-party administrator must notify the health care provider 
  1.23  of the reasons for this determination within 30 calendar days 
  1.24  after the date upon which the health plan company or third-party 
  1.25  administrator received the claim.  Where evidence of suspected 
  2.1   fraud is present, the requirement to disclose the reasons for 
  2.2   the determination that a claim is not clean need not be specific.
  2.3      (c) If a health plan company or third-party administrator 
  2.4   does not pay or deny a clean claim within the period provided in 
  2.5   paragraph (a), the health plan company or third-party 
  2.6   administrator must pay interest on the claim for the period 
  2.7   beginning on the day after the required payment date specified 
  2.8   in paragraph (a) and ending on the date on which the health plan 
  2.9   company or third-party administrator makes the payment or denies 
  2.10  the claim.  In any payment, the health plan company or 
  2.11  third-party administrator must itemize any interest payment 
  2.12  being made separately from other payments being made for 
  2.13  services provided.  The health plan company or third-party 
  2.14  administrator may, at its discretion, require the health care 
  2.15  provider to bill the health plan company or third-party 
  2.16  administrator for the interest required under this section 
  2.17  before any interest payment is made. Interest payments must be 
  2.18  made to the health care provider no less frequently than 
  2.19  quarterly. 
  2.20     (c) (d) The rate of interest paid by a health plan company 
  2.21  or third-party administrator under this subdivision shall be 1.5 
  2.22  percent per month or any part of a month. 
  2.23     (d) (e) A health plan company or third-party administrator 
  2.24  is not required to make an interest payment on a claim for which 
  2.25  payment has been delayed for purposes of reviewing potentially 
  2.26  fraudulent or abusive billing practices. 
  2.27     (e) The commissioner may not assess a financial 
  2.28  administrative penalty against a health plan company for 
  2.29  violation of this subdivision.