Report Title:
Health Insurance Unfair Claims Practices
Description:
Clarifies that a "clean claim" cannot be contested by a health insurer under procedures for reimbursement for health insurance benefits; defines "clean claim".
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THE SENATE |
S.B. NO. |
171 |
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TWENTY-FIRST LEGISLATURE, 2001 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to health insurance reimbursement.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Section 431:13-108, Hawaii Revised Statutes, is amended as follows:
1. By amending subsection (b) to read:
"(b) Unless shorter payment timeframes are otherwise specified in a contract, an entity shall reimburse a claim that is not contested or denied not more than thirty calendar days after receiving the claim filed in writing, or fifteen calendar days after receiving the claim filed electronically, as appropriate. An entity shall not contest a clean claim; provided that an entity may request additional information under subsection (d)."
2. By adding a new definition to subsection (i) to be appropriately inserted and to read:
""Clean claim" means a claim in which the information in the possession of an entity adequately indicates that the:
(1) Insured is covered under the policy for the type of services received;
(2) Individual making the claim is the individual receiving the benefits under the policy;
(3) Physician providing the services is qualified to provide the services under the State's laws; and
(4) Policy covers the services provided."
SECTION 2. New statutory material is underscored.
SECTION 3. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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