Senate Bill No. [insert bill number] aims to revise laws related to payments made by health carriers in Montana, establishing requirements for prompt payment, clean claim procedures, and penalties for noncompliance. 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 days for others. 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 issues are not resolved within a specified timeframe. 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 provisions of the bill are 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: 33-31-111