The bill amends Section 33-1-111 of the Montana Code Annotated to establish additional protections for claims submitted by the Department of Public Health and Human Services (DPHHS) regarding health care items or services. Specifically, it prohibits parties that are legally responsible for payment from denying claims based solely on the date of submission, the type or format of the claim form, or the failure to obtain prior authorization for the item or service, provided that the claim is submitted within three years of the service and any enforcement action is initiated within six years.

The new legal language inserted into the bill clarifies that the failure to obtain prior authorization cannot be used as a basis for denial of a claim. This amendment aims to ensure that eligible individuals receive the necessary health care services without undue barriers related to administrative processes. The bill also outlines that it does not impose liability on entities for claims they do not bear or require payment for services not covered under applicable health care plans.

Statutes affected:
LC Text: 33-1-111
SB0361_1(1): 33-1-111
SB0361_1(2): 33-1-111
SB0361_1(3): 33-1-111
SB0361_1(4): 33-1-111
SB0361_1: 33-1-111
SB0361_X(1): 33-1-111
SB0361_X(10): 33-1-111
SB0361_X(11): 33-1-111
SB0361_X(12): 33-1-111
SB0361_X(13): 33-1-111
SB0361_X(2): 33-1-111
SB0361_X(3): 33-1-111
SB0361_X(4): 33-1-111
SB0361_X(5): 33-1-111
SB0361_X(6): 33-1-111
SB0361_X(7): 33-1-111
SB0361_X(8): 33-1-111
SB0361_X(9): 33-1-111
SB0361_X: 33-1-111