This bill amends existing legislation to prohibit health insurance carriers from denying payment of claims while they are seeking coordination of benefits information, regardless of whether they have good cause to believe that other insurance coverage is available. This change aims to prevent delays in claim payments due to the carrier's inquiries about potential other insurance. Additionally, the bill establishes a framework for timely processing and payment of claims, requiring health insurance carriers to adhere to strict timelines for payment, notification of incomplete claims, and the handling of disputes through an internal appeal mechanism.

Furthermore, the bill introduces penalties for late payments, including the accrual of interest at a rate of 12% per annum on overdue payments. It outlines the arbitration process for disputes, mandating that arbitration can only be initiated within 90 days of an appeal determination for disputes involving amounts of $1,000 or more. The arbitrator's decisions will be binding and non-appealable, with specific requirements for documentation and timelines for issuing determinations. Overall, the legislation aims to enhance the efficiency and fairness of the claims process for healthcare 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