2004 Minnesota Statutes

     62Q.75 Prompt payment required. 

    Subdivision 1.    Definitions.  (a) For purposes of this 
 section, the following terms have the meanings given to them. 

    (b) "Clean claim" means a claim that has no defect or 
 impropriety, including any lack of any required substantiating 
 documentation, or particular circumstance requiring special 
 treatment that prevents timely payment from being made on a 
 claim under this section. 

    (c) "Third-party administrator" means a third-party 
 administrator or other entity subject to section 60A.23, 
 subdivision 8, and Minnesota Rules, chapter 2767. 

    Subd. 2.    Claims payments.  (a) This section applies 
 to clean claims submitted to a health plan company or 
 third-party administrator for services provided by any: 

    (1) health care provider, as defined in section 62Q.74, but 
 does not include a provider licensed under chapter 151; 

    (2) home health care provider, as defined in section 
 144A.43, subdivision 4; or 

    (3) health care facility. 

 All health plan companies and third-party administrators must 
 pay or deny claims that are clean claims within 30 calendar days 
 after the date upon which the health plan company or third-party 
 administrator received the claim. 

    (b) The health plan company or third-party administrator 
 shall, upon request, make available to the provider information 
 about the status of a claim submitted by the provider consistent 
 with section 62J.581. 

    (c) If a health plan company or third-party administrator 
 does not pay or deny a clean claim within the period provided in 
 paragraph (a), the health plan company or third-party 
 administrator must pay interest on the claim for the period 
 beginning on the day after the required payment date specified 
 in paragraph (a) and ending on the date on which the health plan 
 company or third-party administrator makes the payment or denies 
 the claim.  In any payment, the health plan company or 
 third-party administrator must itemize any interest payment 
 being made separately from other payments being made for 
 services provided.  Interest payments must be made to the health 
 care provider no less frequently than quarterly. 

    (d) The rate of interest paid by a health plan company or 
 third-party administrator under this subdivision shall be 1.5 
 percent per month or any part of a month. 

    (e) A health plan company or third-party administrator is 
 not required to make an interest payment on a claim for which 
 payment has been delayed for purposes of reviewing potentially 
 fraudulent or abusive billing practices. 

    (f) The commissioner may assess a financial administrative 
 penalty against a health plan company for violation of this 
 subdivision when there is a pattern of abuse that demonstrates a 
 lack of good faith effort and a systematic failure of the health 
 plan company to comply with this subdivision. 

    HIST: 2000 c 349 s 1; 2004 c 246 s 10