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H0089...........................................................by BUSINESS
INSURANCE CLAIMS - Amends existing law relating to health insurance claims
to revise time periods applicable to notification requirements.
02/02 House intro - 1st rdg - to printing
02/03 Rpt prt - to Bus
02/18 Rpt out - rec d/p - to 2nd rdg
02/21 2nd rdg - to 3rd rdg
02/23 3rd rdg - PASSED - 70-0-0
AYES -- Anderson, Andrus, Barraclough, Barrett, Bastian, Bayer,
Bedke, Bell, Bilbao, Black, Block, Boe, Bolz, Bradford, Cannon,
Chadderdon, Clark, Collins, Crow, Deal, Denney, Edmunson, Ellsworth,
Eskridge, Field(18), Field(23), Garrett, Hart, Harwood, Henbest,
Henderson, Jaquet, Jones, Kemp, Lake, LeFavour, Loertscher, Martinez,
Mathews, McGeachin, McKague, Miller, Mitchell, Moyle, Nielsen,
Nonini, Pasley-Stuart, Pence, Raybould, Ring, Ringo, Roberts, Rusche,
Rydalch, Sali, Sayler, Schaefer, Shepherd(2), Shepherd(8), Shirley,
Skippen, Smith(30), Smith(24), Smylie, Snodgrass, Stevenson, Trail,
Wills, Wood, Mr. Speaker
NAYS -- None
Absent and excused -- None
Floor Sponsor - Rusche
Title apvd - to Senate
02/24 Senate intro - 1st rdg - to Com/HuRes
03/09 Rpt out - rec d/p - to 2nd rdg
03/10 2nd rdg - to 3rd rdg
03/11 3rd rdg - PASSED - 32-0-2, 1 vacancy
AYES -- Andreason, Brandt, Broadsword, Bunderson, Burkett,
Burtenshaw, Cameron, Coiner, Compton, Corder, Darrington, Davis,
Gannon, Geddes, Goedde, Jorgenson, Kelly, Keough, Langhorst, Little,
Lodge, Malepeai, Marley, McGee, McKenzie, Pearce, Richardson,
Schroeder, Stegner, Stennett, Werk, Williams
NAYS -- None
Absent and excused -- Hill, Sweet, (District 21 seat vacant)
Floor Sponsor - Malepeai
Title apvd - to House
03/14 To enrol
03/15 Rpt enrol - Sp signed
03/16 Pres signed
03/17 To Governor
03/21 Governor signed
Session Law Chapter 66
Effective: 07/01/05
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-eighth Legislature First Regular Session - 2005
IN THE HOUSE OF REPRESENTATIVES
HOUSE BILL NO. 89
BY BUSINESS COMMITTEE
1 AN ACT
2 RELATING TO INSURANCE; AMENDING SECTION 41-5602, IDAHO CODE, TO REVISE TIME
3 PERIODS APPLICABLE TO NOTIFICATION REQUIREMENTS.
4 Be It Enacted by the Legislature of the State of Idaho:
5 SECTION 1. That Section 41-5602, Idaho Code, be, and the same is hereby
6 amended to read as follows:
7 41-5602. PROMPT PAYMENT OF CLAIMS. (1) Except as otherwise specifically
8 provided in this chapter, an insurer shall process a claim for payment for
9 health care services rendered by a practitioner or facility to a beneficiary
10 in accordance with this section.
11 (2) If a beneficiary, practitioner or facility submits an electronic
12 claim to an insurer within thirty (30) days of the date on which service was
13 delivered, an insurer shall pay or deny the claim not later than thirty (30)
14 days after receipt of the claim.
15 (3) If a beneficiary, practitioner or facility submits a paper claim for
16 payment to an insurer within forty-five (45) days of the date on which service
17 was delivered, an insurer shall pay or deny the claim not later than forty-
18 five (45) days after receipt of the claim.
19 (4) If an insurer denies the claim or needs additional information to
20 process the claim, the insurer shall notify the practitioner or facility and
21 the beneficiary in writing within thirty (30) days of receipt of the an elec-
22 tronic claim or within forty-five (45) days of receipt of a paper claim. The
23 notice shall state why the insurer denied the claim.
24 (5) If the claim was denied because more information was required to
25 process the claim, the notice shall specifically describe all information and
26 supporting documentation needed to evaluate the claim for processing. If the
27 practitioner or facility submits the information and documentation identified
28 by the insurer within thirty (30) days of receipt of the written notice, the
29 insurer shall process and pay the claim within thirty (30) days of receipt of
30 the additional information or, if appropriate, deny the claim.
31 (6) Any claim submitted pursuant to this chapter shall use the current
32 procedural terminology (CPT) code in effect, as published by the American med-
33 ical association, the international classification of disease (ICD) code in
34 effect, as published by the United States department of health and human ser-
35 vices, or the healthcare common procedural coding system (HCPCS) code in
36 effect, as published by the United States centers for medicaid and medicare
37 services (CMS).
38 (7) This chapter shall not apply to claims submitted under policies or
39 certificates of insurance for specific disease, hospital confinement indem-
40 nity, accident-only, credit, medicare supplement, disability income insurance,
41 student health benefits only coverage issued as a supplement to liability
42 insurance, worker's compensation or similar insurance, automobile medical pay-
43 ment insurance or nonrenewable short-term coverage issued for a period of
2
1 twelve (12) months or less.
STATEMENT OF PURPOSE
RS 14511
This bill corrects an oversight in House Bill 835 that was passed
during the 2004 session, providing for prompt payment of health
insurance claims. The original bill should have allowed 45 days
for an insurer to request additional information when presented
with a paper claim. This bill simply corrects that oversight.
FISCAL IMPACT
This bill will have no impact on the General Fund.
Contacts: Ken McClure
388-1200
STATEMENT OF PURPOSE/FISCAL NOTE H 89