2005 Legislation
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HOUSE BILL NO. 89 – Insurance claims, notificatn reqmt


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Bill Status

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

Bill Text

  ]]]]              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
  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
  1    twelve (12) months or less.

Statement of Purpose / Fiscal Impact

                      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
STATEMENT OF PURPOSE/FISCAL NOTE                        H 89