Senate Bill No. [insert bill number] aims to revise laws related to payments made by health carriers in Montana, establishing prompt payment requirements and procedures for clean claims. The bill introduces definitions for key terms such as "clean claim," "health carrier," and "enrollee," and mandates that health carriers must issue payments for clean claims within specified timeframes—14 calendar days for electronic submissions and 30 calendar days for other submissions. Additionally, the bill outlines procedures for notifying providers of any deficiencies in claims and stipulates that health carriers must pay interest on late payments, with specific rates and conditions.

The bill also grants enforcement authority to the Commissioner of Insurance and the Department of Justice, allowing them to impose penalties for noncompliance, including civil penalties and restitution. It provides a private right of action for individuals aggrieved by violations of the new provisions, enabling them to seek legal recourse if their claims are not handled appropriately. Furthermore, the bill amends Section 33-31-111 of the Montana Code Annotated to clarify the relationship between health maintenance organizations and other insurance laws, ensuring that the new payment requirements are integrated into existing regulations. The act is set to apply to claims filed on or after January 1, 2026.

Statutes affected:
LC Text: 33-31-111
SB0448_1(1): 33-31-111
SB0448_1(2): 33-31-111
SB0448_1(3): 33-31-111
SB0448_1(4): 33-31-111
SB0448_1: 33-31-111