The bill amends Section 33-1-111 of the Montana Code Annotated to establish additional conditions under which parties responsible for health care claims cannot deny claims submitted by the Department of Public Health and Human Services (DPHHS). Specifically, it prohibits denial of 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 by DPHHS is initiated within six years.

The bill also requires health insurance issuers and other responsible parties to provide eligibility information for Medicaid recipients upon request and to respond to inquiries regarding claims within a specified timeframe. It clarifies that the new provisions do not require third parties to pay for services not covered under their health care plans or impose liability for claims they do not bear. The amendments aim to streamline the claims process and ensure that Medicaid recipients receive the necessary health care services without undue barriers.

Statutes affected:
LC Text: 33-1-111
SB0361_1(1): 33-1-111
SB0361_1: 33-1-111