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,
including, but not limited to, coordination of benefits information, or particular circumstance requiring special treatment
that prevents timely payment from being made on a claim under this section. Nothing in this section alters an enrollee's obligation
to disclose information as required by law.(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
, 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
.(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.
The health plan company or third-party administrator shall not require the health care provider to bill the health plan company
or third-party administrator for the interest required under this section before any interest payment is made. 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.
Subd. 3. Claims filing.
Unless otherwise provided by contract, by section
16A.124, subdivision 4a
, or by federal law, the health care providers and facilities specified in subdivision 2 must submit their charges to a health
plan company or third-party administrator within six months from the date of service or the date the health care provider
knew or was informed of the correct name and address of the responsible health plan company or third-party administrator,
whichever is later. A health care provider or facility that does not make an initial submission of charges within the six-month
period shall not be reimbursed for the charge and may not collect the charge from the recipient of the service or any other
payer. The six-month submission requirement may be extended to 12 months in cases where a health care provider or facility
specified in subdivision 2 has determined and can substantiate that it has experienced a significant disruption to normal
operations that materially affects the ability to conduct business in a normal manner and to submit claims on a timely basis.
This subdivision also applies to all health care providers and facilities that submit charges to workers' compensation payers
for treatment of a workers' compensation injury compensable under chapter 176, or to reparation obligors for treatment of
an injury compensable under chapter 65B.
History: 2000 c 349 s 1; 2004 c 246 s 10; 2005 c 77 s 4