This bill amends the state Medicaid procedures to establish the acceptance of liability by health carriers to third parties. It mandates that health carriers must acknowledge the state's right of recovery and the assignment to the state or its designated managed care organizations of any right to payment for services covered by the state plan. The bill requires health carriers to respond to any state inquiries about claims within 60 days and to not deny claims based on submission date, claim form type or format, or lack of proper documentation at the point-of-sale, provided that the claim is submitted within three years of service provision and action on the claim is commenced within six years.

The bill also specifies that health carriers cannot deny claims for reasons such as unknown policyholder information, lack of coordination of benefits authorization, absence of a National Provider Identifier (NPI) on the claim, or lack of prior authorization from the third party. It states that the payment of a claim by the state or its designated managed care organizations is equivalent to having obtained prior authorization for the medical service from the third party. The act is set to take effect on July 1, 2024.

Statutes affected:
Introduced: 167:4-b
Version adopted by both bodies: 167:4-b
CHAPTERED FINAL VERSION: 167:4-b