The bill aims to revise laws related to payments made by health carriers, establishing prompt payment requirements and procedures for clean claims, as well as penalties for noncompliance. It introduces definitions for key terms such as "clean claim," "health carrier," and "enrollee," and mandates that health carriers must process clean claims within specified timeframes—14 calendar days for electronic submissions and 30 calendar days for others. If a claim is deemed not clean, health carriers are required to notify the provider of any deficiencies within a set timeframe, and they must pay interest on late payments.

Additionally, the bill grants enforcement authority to the Commissioner of Insurance and the Department of Justice, allowing them to impose penalties for noncompliance, including civil penalties and restitution. It also provides a private right of action for individuals aggrieved by violations of the new provisions. The bill amends existing law to incorporate these changes and specifies that it will apply to claims filed on or after January 1, 2026.

Statutes affected:
LC Text: 33-31-111
SB0448_1(1): 33-31-111
SB0448_1(2): 33-31-111
SB0448_1: 33-31-111