Senate Bill 1584er

    ENROLLED

    1998 Legislature                                CS for SB 1584



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  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.




    ENROLLED

    1998 Legislature                                CS for SB 1584



  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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