MISSISSIPPI LEGISLATURE

2000 Regular Session

To: Insurance

By: Senator(s) Kirby

AN ACT TO REQUIRE PROMPT PAYMENT BY HEALTH PLAN COMPANIES AND THIRD-PARTY ADMINISTRATORS OF CLEAN CLAIMS FOR HEALTH CARE SERVICES; TO AUTHORIZE ADMINISTRATIVE FINES FOR VIOLATIONS OF THE ACT; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1. (1) As used in this act unless the context clearly indicates otherwise:

(a) "Clean claim" means a claim that has no defect or impropriety, including any lack of any required substantiating documentation, or particular circumstance requiring special treatment that prevents timely payment form being made on a claim under this section.

(b) "Third-party administrator" means a third-party administrator as defined in Section 83-18-1.

(2) This act applies to clean claims submitted to a health plan company or third-party administrator for services provided by any health care provider or health care facility. All health plan companies and third-party administrators must issue, mail or otherwise transmit payment:

(a) For paper claims that are clean claims, within thirty (30) calendar days after the date upon which the health plan company or third-party administrator received the claim; and

(b) For electronic claims that are clean claims, within fourteen (14) calendar days after the date upon which the health plan company or their-party administrator received the claim.

(3) If a health plan company or third-party administrator does not issue, mail or otherwise transmit payment within the period provided in subsection (2), the health plan company or third-party administrator must pay interest on the claim for the period beginning on the day after the required payment date specified in subsection (2) and ending on the date on which the health plan company or third-party administrator makes the payment. The interest must be calculated and disbursed in the same manner as under United States Code, Title 42, Section 1395h(g). In any payment, the health plan company or third-party administrator must itemized any interest payment being made separately from other payments being made for services provided.

(4) The rate of interest paid by a health plan company or third-party administrator under this act shall be one and one-half percent (1.5%) per month of any part of a month.

(5) (a) A health care provider or health care facility may report any violation of subsection (2), by a health plan company or third-party administrator to the commissioner with regulatory authority over the health plan company or third-party administrator.

(b) If the Commissioner of Insurance determines that a health plan company or third-party administrator violated subsection (2) ten (10) times or more in a calendar year for a single individual or entity submitting claims, the commissioner shall levy a fine not to exceed Five Thousand Dollars ($5,000.00) upon the tenth violation. The fine collected shall be divided equally between the Department of Insurance Special Fund and the individual or entity that submitted the claims. The commissioner shall give reasonable notice in writing to the health plan company or third-party administrator of the intent to levy a fine and the reasons for the fine.

SECTION 2. This act shall take effect and be in force from and after July 1, 2000.