This bill amends RSA 415:6-i to prohibit insurers from conducting audits of provider services after the services have been delivered but before payment has been made to the provider. The new legal language inserted into the law states, "No insurer may conduct an audit of provider services after services have been delivered but before payment has been made to such provider." If an insurer violates this provision, they are required to promptly pay the provider for the services rendered, hold the patient harmless for any co-pay or co-insurance obligations, and remit interest at a rate of 15 percent per annum from the date of service until payment is made. Additionally, insurers found in violation of this rule waive their rights to retrospectively review the services that were subject to the impermissible audit.

The bill also outlines that if an audit is conducted in violation of the new provision, the insurer must reimburse the provider for all costs incurred in enforcing this rule. The fiscal impact of the bill is indeterminable, as it may lead to increased premiums for health carriers to offset the costs associated with additional claims payments and penalties. The overall financial implications for local and county governments that purchase health insurance are also uncertain, with potential increases in Insurance Premium Tax revenue due to the changes in claims payment practices. The act is set to take effect 60 days after its passage.

Statutes affected:
Introduced: 415:6-i