2006 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, 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 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. 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