This bill amends existing legislation to enhance the claims process for health insurance by prohibiting carriers from denying payment of claims while seeking coordination of benefits information, regardless of whether they believe other insurance coverage exists. The previous requirement that payment could only be denied if there was "good cause" has been removed. Additionally, the bill establishes strict timelines for the processing and payment of claims, mandates that overdue payments accrue interest at a rate of 12% per annum, and outlines the obligations of health insurance carriers to notify providers about claim disputes and incomplete claims.

Furthermore, the bill introduces a framework for arbitration of disputes related to claims, ensuring that the process is efficient and binding. It specifies that disputes can be initiated within 90 days of receiving a determination and sets a minimum threshold for arbitration eligibility. The bill also clarifies that health care providers cannot seek reimbursement for underpayments after 18 months unless certain conditions are met. Overall, the legislation aims to streamline the claims process, enhance accountability, and protect the rights of both health care providers and covered individuals.

Statutes affected:
Introduced: 17:48-8.4, 17:48A-7.12, 17:48E-10.1, 17:48F-13.1, 17B:26-9.1, 17B:27-44.2, 26:2J-8.1