CSHB 113(L&C): "An Act relating to health care insurance payments for hospital or medical services; and providing for an effective date."
00 CS FOR HOUSE BILL NO. 113(L&C) 01 "An Act relating to health care insurance payments for hospital or medical services; and 02 providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. AS 21.54.020 is repealed and reenacted to read: 05 Sec. 21.54.020. Required insurer payment for hospital and medical 06 services. (a) A health care insurer shall pay indemnities under a group health 07 insurance policy or subscriber benefits under a group hospital or medical service 08 subscriber contract, whether or not services were provided by participant providers, 09 within 30 calendar days after receipt of a clean claim. 10 (b) If a claim is not paid as required under (a) of this section, the health care 11 insurer shall give notice of the specific items necessary for the claim to be adjudicated 12 to the covered person and, if the claim was assigned, to the provider of the hospital, 13 nursing, medical, dental, or surgical services. Notice required under this subsection is 14 required to be given by the date specified for payment of an indemnity under (a) of
01 this section. 02 (c) If notice of the specific items necessary for a claim to be adjudicated is not 03 given as required in (b) of this section, the claim is presumed to be a clean claim, and 04 interest accrues beginning on the day following the day notice is due and shall be 05 added to the claim until the claim is paid. The rate of interest required under this 06 subsection is the maximum rate provided for the financing of premiums under 07 AS 06.40.120. If a claim made is only partially covered under the insurance contract, 08 the interest accrued shall be based on the amount of the claim that is covered under the 09 contract. 10 (d) A claim for which a health care insurer provides appropriate notice of a 11 deficiency under (b) of this section must be paid within five working days after receipt 12 of those items listed as being deficient. If payment is not made within five working 13 days, the claim is presumed to be a clean claim, interest accrues at the rate allowed in 14 (c) of this section, and the interest shall be added to the claim until the claim is paid. 15 If a claim is only partially covered under the insurance contract, the interest accrued 16 shall be based on the amount of the claim that is covered under the contract. 17 (e) Upon written request of a covered person, a health care insurer shall pay 18 amounts due under (a), (b), (c), or (d) of this section directly to the provider of the 19 hospital, nursing, medical, dental, or surgical services. The policy may not contain a 20 provision requiring that services be provided by a particular hospital or person, except 21 as applicable to a health maintenance organization under AS 21.86. If the health care 22 insurer makes a claim payment to the covered person after the covered person has 23 given written notice electing direct payment to the provider of the service, the health 24 care insurer shall also pay that amount to the provider of the service. 25 (f) A covered person may revoke an election of direct claim payment made 26 under (e) of this section by giving written notice of the revocation to the health care 27 insurer and to the provider of the service. The written notice of revocation to the 28 health care insurer must certify that the covered person has given written notice of 29 revocation to the provider of the service. Revocation of an election of direct claim 30 payment is not effective until the notice of revocation is received by the health care 31 insurer and the provider of the service, whichever date is later.
01 (g) The right of the covered person to request payment of indemnities under a 02 blanket health insurance policy directly to the provider of the services or to another 03 person may be transferred by a qualified domestic relations order to a person who is 04 not the covered person. Rights under the qualified domestic relations order do not 05 take effect until the order is received by the health care insurer. In this subsection, 06 "qualified domestic relations order" means an order or judgment in a divorce or 07 dissolution action under AS 25.24 that designates a person to determine to whom 08 indemnities for a covered person should be paid under a health insurance policy. 09 (h) This section does not prohibit a health care insurer from recovering an 10 amount mistakenly paid to a provider or a covered person. 11 (i) Within 30 working days after the end of each calendar quarter, a health 12 care insurer shall file with the director a report that shows, for the previous calendar 13 quarter, the percentage of claims paid in this state during that quarter that meets the 14 time limits imposed under (a) and (d) of this section. 15 (j) For the purpose of this section, a claim shall be considered paid on the day 16 payment is either mailed or transmitted electronically. 17 (k) If interest is required to be added to a claim under (c) or (d) of this section, 18 the amount added may not be included when calculating an applicable cap on benefits 19 payable to the covered person or other person claiming payments under the health 20 insurance policy. 21 (l) In this section, 22 (1) "calendar quarter" has the meaning given in AS 23.20.520; 23 (2) "clean claim" means a claim that does not have a defect, 24 impropriety, or circumstance requiring special treatment that precludes timely 25 payment on the claim. 26 * Sec. 2. AS 25.24.160(b) is amended to read: 27 (b) If a judgment under this section distributes benefits to an alternate payee 28 under AS 14.25, AS 21.51.120(a), AS 21.54.020(g) [AS 21.54.020(c)], 21.54.050(c), 29 AS 22.25, AS 26.05.222 - 26.05.226, or AS 39.35, the judgment must meet the 30 requirements of a qualified domestic relations order under the definition of that phrase 31 that is applicable to those provisions.
01 * Sec. 3. AS 25.24.230(h) is amended to read: 02 (h) If a judgment under this section distributes benefits to an alternate payee 03 under AS 14.25, AS 21.51.120(a), AS 21.54.020(g) [AS 21.54.020(c)], 21.54.050(c), 04 AS 22.25, AS 26.05.222 - 26.05.226, or AS 39.35, the judgment must meet the 05 requirements of a qualified domestic relations order under the definition of that phrase 06 that is applicable to those provisions. 07 * Sec. 4. This Act takes effect January 1, 2002.