Senate Bill 0796

    Florida Senate - 1998                                   SB 796

    By Senator Silver





    38-397-98

  1                      A bill to be entitled

  2         An act relating to health maintenance

  3         organizations; requiring a health maintenance

  4         organization to reimburse providers of covered

  5         services for services provided to the

  6         organization's members; providing guidelines

  7         for such reimbursement; providing penalties for

  8         noncompliance; providing for interest on

  9         overdue claims payments; providing an exception

10         for good faith disputes over the legitimacy of

11         claims or the amount of reimbursement;

12         providing an effective date.

13

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

15

16         Section 1.  (1)  For covered services provided to its

17  members, a health maintenance organization shall reimburse any

18  provider within 30 days after the receipt of a claim that is

19  accompanied by all reasonable and necessary documentation.

20         (2)  If a health maintenance organization fails to

21  comply with the requirements of subsection (1), the health

22  maintenance organization must pay interest beginning with the

23  31st day on the amount of the claim which remains unpaid after

24  30 days following the receipt of the claim. The interest

25  payable is at the rate of 1.5 percent per month simple

26  interest, prorated for any portion of a month.

27         (3)  Except as provided in subsection (4), when a

28  health maintenance organization pays a claim more that 30 days

29  after its receipt, the organization shall add the interest

30  payable to the amount of the unpaid claim without the

31

                                  1

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






    Florida Senate - 1998                                   SB 796
    38-397-98




  1  necessity for any claim for that interest being made by the

  2  provider filing the original claim.

  3         (4)  This section does not apply to claims when there

  4  is a good-faith dispute regarding the legitimacy of the claim

  5  or the appropriate amount of reimbursement, and the health

  6  maintenance organization:

  7         (a) Notifies the provider within 2 weeks of the receipt

  8  of the claim that the legitimacy of the claim or the

  9  appropriate amount of reimbursement is in dispute;

10         (b) Supplies in writing to the provider the specific

11  reasons why the legitimacy of the claim, or a portion of the

12  claim, or the appropriate amount of reimbursement is in

13  dispute;

14         (c) Pays any undisputed portion of the claim within 30

15  days of the receipt of the claim; and

16         (d) Makes a good-faith, timely effort to resolve the

17  dispute.

18         Section 2.  This act shall take effect July 1, 1998.

19

20            *****************************************

21                          SENATE SUMMARY

22    Requires health maintenance organizations to reimburse
      providers of covered services for services provided to
23    the organizations' members. Provides guidelines for such
      reimbursements. Provides penalties for noncompliance.
24    Provides for interest to be assessed on overdue claims
      payments. Provides an exception from the requirements for
25    organizations involved in good-faith disputes over the
      legitimacy of claims or the amount of reimbursement.
26

27

28

29

30

31

                                  2