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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 thean 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