The bill amends Section 33-1-111 of the Montana Code Annotated to establish additional criteria 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 present proper documentation at the point of sale, provided that the claim is submitted within three years of the service and any enforcement action is initiated within six years. A significant insertion in the bill is the stipulation that claims cannot be denied due to the failure to obtain prior authorization for the item or service according to the third-party payer's rules.

The bill also outlines the obligations of health insurance issuers and other entities responsible for payment, including the requirement to provide eligibility information for Medicaid recipients and respond to inquiries regarding claims. It clarifies that the new provisions do not require third parties to pay claims for services not covered under their health care plans or impose liability beyond what is already established in their plan documents. Overall, the bill aims to enhance the ability of DPHHS to recover costs for health care services provided to Medicaid recipients.

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