Senate Bill 1584c1
CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 1584
By the Committee on Banking and Insurance and Senators
Campbell and Forman
311-2038A-98
1 A bill to be entitled
2 An act relating to health maintenance
3 organizations; creating s. 641.3155, F.S.;
4 prescribing time for paying claims for services
5 or goods by a provider; providing procedures
6 for denying or contesting a claim; providing
7 time limitations; providing notice; providing
8 method for making payments, denying or
9 contesting a claim, and providing notice;
10 providing interest on overdue payment of claim;
11 providing for a waiver of a health maintenance
12 organization's rights under a provider contract
13 and consequences for failure of an organization
14 to comply with the provisions of the act;
15 providing an effective date.
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17 Be It Enacted by the Legislature of the State of Florida:
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19 Section 1. Section 641.3155, Florida Statutes, is
20 created to read:
21 641.3155 Provider contracts; payment of claims.--
22 (1)(a) A health maintenance organization shall pay any
23 claim or any portion of a claim made by a contract provider
24 for services or goods provided under a contract with the
25 health maintenance organization which the organization does
26 not contest or deny within 35 days after receipt of the claim
27 by the health maintenance organization which is mailed or
28 electronically transferred by the provider.
29 (b) A health maintenance organization that denies or
30 contests a provider's claim shall notify the contract
31 provider, in writing, within 35 days after receipt of the
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 1584
311-2038A-98
1 claim by the health maintenance organization that the claim is
2 contested or denied. The notice that the claim is denied or
3 contested must identify the contested portion of the claim and
4 the specific reason for contesting or denying the claim, and
5 may include a request for additional information. If the
6 health maintenance organization requests additional
7 information, the provider shall, within 35 days after receipt
8 of such request, mail or electronically transfer the
9 information to the health maintenance organization. The health
10 maintenance organization shall pay or deny the claim or
11 portion of the claim within 45 days after receipt of the
12 information.
13 (2) Payment of a claim is considered made on the date
14 the payment was received or electronically transferred or
15 otherwise delivered. An overdue payment of a claim bears
16 simple interest at the rate of 10 percent per year.
17 (3) A health maintenance organization shall pay or
18 deny any claim no later than 120 days after receiving the
19 claim.
20 Section 2. This act shall take effect October 1, 1998.
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CODING: Words stricken are deletions; words underlined are additions.
Florida Senate - 1998 CS for SB 1584
311-2038A-98
1 STATEMENT OF SUBSTANTIAL CHANGES CONTAINED IN
COMMITTEE SUBSTITUTE FOR
2 Senate Bill 1584
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4 The bill requires a health maintenance organization to
reimburse all claims or any portion of any claim made by a
5 provider for services or goods provided under contract with
the health maintenance organization which the health
6 maintenance organization does not contest or deny within 35
days after receipt of the claim by the health maintenance
7 organization.
8 If the health maintenance organization requests additional
information, the provider must submit the information within
9 35 days of receipt of such request. Upon receipt of the
additional information, the health maintenance organization
10 must pay or deny the contested claim or portion of the
contested claim within 45 days after receipt of the
11 information.
12 In any event, the health maintenance organization must pay or
deny any claim no later than 120 days after receiving the
13 claim.
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