This bill amends existing legislation to enhance the claims processing and payment procedures for health insurance carriers. A significant change is the prohibition against denying payment on claims while seeking coordination of benefits information, regardless of whether the carrier has good cause to believe that other insurance coverage exists. This aims to prevent delays in claim payments due to the carrier's inquiries about potential other insurance. The bill also establishes strict timelines for the processing and payment of claims, requiring health insurance carriers to remit payments within specified timeframes and mandating that overdue payments accrue interest at a rate of 12% per annum.

Additionally, the bill introduces a framework for internal appeals and arbitration for disputes between health care providers and payers. It outlines the responsibilities of health insurance carriers in notifying providers about claim disputes and establishes penalties for non-compliance with the new regulations. The arbitration process is designed to be efficient, with specific timelines for decisions and requirements for documentation, ensuring that disputes are resolved fairly and promptly. Overall, the legislation aims to streamline the claims process, enhance efficiency, and ensure timely payments to 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