The bill amends several sections of the General Laws to enhance the accountability and efficiency of claims processing in the healthcare sector. Specifically, it introduces a new definition of "unprofessional conduct" for medical professionals, which includes failing to submit medical bills to health insurers based solely on the nature of the claim, particularly those arising from third-party incidents (excluding workers' compensation claims). Additionally, the bill establishes strict timeframes for health care entities and health plans to process claims—40 days for written claims and 30 days for electronic claims—and prohibits the denial of claims solely due to their association with third-party incidents.

Moreover, the bill outlines the responsibilities of healthcare entities regarding claim denials, requiring them to notify providers or policyholders within 30 days of the reasons for denial. It also stipulates that interest will accrue on unpaid claims at a rate of 12% per annum if not reimbursed within the specified timeframes. Exceptions to these requirements are included for situations beyond the control of the healthcare provider or entity, and provisions inconsistent with the new regulations will be deemed void. Overall, the amendments aim to ensure timely payments to healthcare providers and policyholders while reinforcing the obligation of health care entities to process claims fairly.

Statutes affected:
5561: 5-37-5.1, 27-18-61, 27-19-52, 27-20-47, 27-41-64