House Bill 1843c1

    Florida House of Representatives - 1998             CS/HB 1843

        By the Committee on Health Care Standards & Regulatory
    Reform and Representatives Effman, Lippman and Brooks





  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, providing notice; providing

10         interest on overdue payment of claim; requiring

11         a health maintenance organization to pay or

12         deny a claim within a time certain; providing

13         an effective date.

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15  Be It Enacted by the Legislature of the State of Florida:

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17         Section 1.  Section 641.3155, Florida Statutes, is

18  created to read:

19         641.3155  Provider contracts; payment of claims.--

20         (1)(a)  A health maintenance organization shall pay any

21  claim or any portion of a claim made by a contract provider

22  for services or goods provided under a contract with the

23  health maintenance organization which the organization does

24  not contest or deny within 35 days after receipt of the claim

25  by the health maintenance organization which may be mailed or

26  electronically transferred by the provider.

27         (b)  A health maintenance organization that denies or

28  contests a provider claim shall notify the contract provider,

29  in writing, within 35 days after receipt of the claim by the

30  health maintenance organization that the claim is contested or

31  denied. The notice that the claim is denied or contested must

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CODING: Words stricken are deletions; words underlined are additions.






    Florida House of Representatives - 1998             CS/HB 1843

    601-142-98






  1  identify the contested portion of the claim and the specific

  2  reason for contesting or denying the claim, and may include a

  3  request for additional information. If the health maintenance

  4  organization requests additional information, the provider

  5  shall, within 35 days after receipt of such request, mail or

  6  electronically transfer the information to the Medicaid health

  7  maintenance organization. The health maintenance organization

  8  shall pay or deny the claim or portion of the claim within 45

  9  days after receipt of the information.

10         (2)  Payment of a claim is considered made on the date

11  the payment was received or electronically transferred or

12  otherwise delivered. An overdue payment of a claim bears

13  simple interest at the rate of 10 percent per year.

14         (3)  A health maintenance organization shall pay or

15  deny any claim no later than 120 days after receiving the

16  claim.

17         Section 2.  This act shall take effect October 1 of the

18  year in which enacted.

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