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BILL AS INTRODUCED 2007-2008

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H.376

Introduced by Representatives Koch of Barre Town, Fisher of Lincoln, Morrissey of Bennington, Mrowicki of Putney and Pugh of S. Burlington

Referred to Committee on

Date:

Subject:  Health; insurance; prompt pay; prescription drugs

Statement of purpose:  This bill proposes to require a health plan to pay by electronic funds transfer within eight days any prescription drug claim submitted electronically.

AN ACT RELATING TO PROMPT PAYMENT OF ELECTRONIC PRESCRIPTION DRUG CLAIMS

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1.  18 V.S.A. § 9418 is amended to read:

§ 9418.  PAYMENT FOR HEALTH CARE SERVICES

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(b)  No later than 45 days following receipt of a claim, a health plan shall do one of the following:

(1)  Pay or reimburse the claim; provided, however, that prescription drug claims submitted electronically shall be paid within eight days by electronic funds transfer unless the claim is contested or denied.

(2)  Notify the claimant in writing that the claim is contested or denied.  The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the health plan to determine liability for the claim.

(c)  If the claim submitted is to a health plan that is a workers’ compensation insurance policy,

(1)  The health plan shall within 45 days following receipt of the claim:

(A)  pay or reimburse the claim; provided, however, that prescription drug claims submitted electronically shall be paid within eight days by electronic funds transfer unless the claim is contested or denied; or

(B)  notify in writing the claimant and the commissioner of labor that the claim is contested or denied.  The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the health plan to determine liability for the claim.

(2)  Disputes regarding any claims under this subsection shall be resolved pursuant to the provisions of chapters 9 and 11 of Title 21.

(3)  The commissioner of labor may assess interest and penalties as provided in subsections (e) and (f) of this section against a health plan that fails to comply with the provisions of this section or any order of the commissioner.  These remedies are in addition to any other penalties available under Title 8 and chapters 9 and 11 of Title 21.

(d)  If a claim is contested because the health plan was not provided with sufficient information to determine payer liability and for which written notice has been provided as required by subdivision (b)(2) of this section, then the health plan shall have 45 days after receipt of the additional information to complete consideration of the claim.

(e)  Interest shall accrue on a claim at the rate of 12 percent per annum calculated as follows:

(1)  For a claim that is uncontested, from the first calendar day following the 45‑day period following the date the claim is received by the health plan.

(2)  For a contested claim, for which notice was provided as required by this section, from the first calendar day after the 45‑day period following the date that sufficient additional information is received.

(3)  For a contested claim for which notice was not provided as required by this section or for which notice was provided later than the 45 days required by subdivision (b)(2) of this section, from the first calendar day after the 45‑day period following the date the original claim was received by the health plan.

(4)  For a claim that was denied, from the first calendar day after the 45‑day period following the date of a final arbitration award, judgment, or administrative order that found a plan to be liable for payment of the claim.

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Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us