Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB550 Compare Versions

Version 1 (Old)

Version 2 (New)

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4		-	An Act
5		-	ENROLLED SENATE
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 58th Legislature (2021)
	34	+
	35	+	ENGROSSED SENATE
6	36		BILL NO. 550 By: Newhouse of the Senate
7	37
8	38		and
9	39
10		-	Pae, McEntire, Davis,
11		-	Provenzano and Phillips of
	40	+	Pae, McEntire and Davis of
12	41		the House
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17	47		An Act relating to health insurance; amen ding 36 O.S.
18	48		2011, Section 1219, which relates to processing
19	49		claims; requiring insurer to provide specific reason
20	50		for denial of clean claims and partial clean claims
21	51		to certain persons within thirty days; requiring
22	52		insurer to include instructions for appea ling denial;
23	53		authorizing certain persons to submit written appeal
24	54		after denial; requiring insurer to provide certain
25	55		response to appeal and contact information of
26	56		department of appeals; and providing an effective
27	57		date.
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33		-	SUBJECT: Health insurance
34		-
35	63		BE IT ENACTED BY THE PEOPLE OF T HE STATE OF OKLAHOMA:
36		-
37	64		SECTION 1. AMENDATORY 36 O.S. 2011, Section 1219, is
38	65		amended to read as follows:
39		-
40	66		Section 1219. A. In the administration, servicing, or
41	67		processing of any accident and health insurance policy, every
42	68		insurer shall reimburse all clean claims of an insured, an assignee
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	70	+	SB550 HFLR Page 2
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43	96		of the insured, or a health care provider within forty -five (45)
44	97		calendar days after receipt of the claim by the insurer.
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46	98		B. As used in this section:
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48		-	ENR. S. B. NO. 550 Page 2
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50	99		1. “Accident and health insurance policy ” or “policy” means any
51	100		policy, certificate, contract, agreement or other instrument that
52	101		provides accident and health insurance, as defined in Section 703 of
53	102		this title, to any person in this state, and any subscriber
54	103		certificate or any evidence of coverage is sued by a health
55	104		maintenance organization to any person in this state;
56		-
57	105		2. “Clean claim” means a claim that has no defect or
58	106		impropriety, including a lack of any required substantiating
59	107		documentation, or particular circumstance requiring special
60	108		treatment that impedes prompt payment; and
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62	109		3. “Insurer” means any entity that provides an accident and
63	110		health insurance policy in this state , including, but not limited
64	111		to, a licensed insurance company, a not -for-profit hospital service
65	112		and medical indemnity corpor ation, a health maintenance
66	113		organization, a fraternal benefit society, a multiple employer
67	114		welfare arrangement, or any other entity subject to regulation by
68	115		the Insurance Commissioner.
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70	116		C. If a claim or any portion of a claim is determined to have
71	117		defects or improprieties, including a lack of any required
72	118		substantiating documentation , or particular circumstance requiring
73	119		special treatment, the insured , enrollee or subscriber, assignee of
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	121	+	SB550 HFLR Page 3
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74	147		the insured, enrollee or subscriber, and health care provider shall
75	148		be notified in writing within thirty (30) calendar days after
76	149		receipt of the claim by the insurer. The written notice shall
77	150		specify the portion of the claim that is causing a delay in
78	151		processing and explain any additional information or corrections
79	152		needed. Failure of an insurer to provide the insured, enrollee or
80	153		subscriber, assignee of the insured, enrollee or subscriber, and
81	154		health care provider with the notice shall constitute prima facie
82	155		evidence that the claim will be paid in accordance with the terms of
83	156		the policy. Provided, if a claim is not submitted into the system
84	157		due to a failure to meet basic Electronic Data Interchange (EDI)
85	158		and/or Health Insurance Portability and Accountability Act (HIPAA)
86	159		edits, electronic notification of the failure to the s ubmitter shall
87	160		be deemed compliance with this subsection. Provided further, health
88	161		maintenance organizations shall not be required to notify the
89	162		insured, enrollee or subscriber, or assignee of the insured,
90	163		enrollee or subscriber of any claim defect or imp ropriety.
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92		-	ENR. S. B. NO. 550 Page 3
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94	164		D. Upon receipt of the additional information or corrections
95	165		which led to the claim ’s being delayed and a determination that the
96	166		information is accurate, an insurer shall either pay or deny the
97	167		claim or a portion of the claim within forty -five (45) calendar
98	168		days.
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100	169		D. If a clean claim or any portion of a clean claim is denied
101	170		for any reason, the insured , enrollee or subscriber, assignee of the
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	172	+	SB550 HFLR Page 4
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102	198		insured, enrollee or subscriber, and health care provider shall be
103	199		notified in writing within thirty (30) calendar days after receipt
104	200		of the claim by the insurer. The written notice shall specify in
105	201		detail the reason for the denial including instructions on where a
106	202		person or entity that received notification may respond through
107	203		dedicated facsimile or electro nic mail message or the address or
108	204		electronic mail message address of the department of appeals of the
109	205		insurer. Upon receiving written notice of denial, a recipient may
110	206		submit a detailed appeal in writing explaining why the claim should
111	207		be approved. If the insurer denies the appeal, the insurer shall
112	208		address in writing the specific details included in the written
113	209		appeal and provide the phone number of a health plan representative
114	210		at the department of appeals of the insurer.
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116	211		E. Payment shall be considered made on:
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118	212		1. The date a draft or other valid instrument which is
119	213		equivalent to the amount of the payment is placed in the United
120	214		States mail in a properly addressed, postpaid envelope; or
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122	215		2. If not so posted, the date of delivery.
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124	216		F. An overdue payment shall bear simple interest at the rate of
125	217		ten percent (10%) per year.
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127	218		G. In the event litigation should ensue based upon such a
128	219		claim, the prevailing party shall be entitled to recover a
129	220		reasonable attorney fee to be set by the court and taxed as costs
130	221		against the party or parties who do not prevail.
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	223	+	SB550 HFLR Page 5
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132	249		H. The Insurance Commissioner shall develop a standardized
133	250		prompt pay form for use by providers in reporting violations of
134	251		prompt pay requirements. The form shall include a requirement that
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136		-	ENR. S. B. NO. 550 Page 4
137	252		documentation of the reason for the delay in payment or
138	253		documentation of proof of payment must be provided within ten (10)
139	254		days of the filing of the form. The Commissioner shall provide the
140	255		form to health maintenance organizations and providers.
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142	256		I. The provisions of this section shall not apply to the
143	257		Oklahoma Life and Health Insurance Guaranty Association or to the
144	258		Oklahoma Property and Casualty Insurance Guaranty Association.
145		-
146	259		SECTION 2. This act shall become effective November 1, 2021.
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148		-
149		-	ENR. S. B. NO. 550 Page 5
150		-	Passed the Senate the 10th day of March, 2021.
151		-
152		-
153		-
154		-	Presiding Officer of the Senate
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157		-	Passed the House of Representatives the 19th day of April, 2021.
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161		-	Presiding Officer of the House
162		-	of Representatives
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164		-	OFFICE OF THE GOVERNOR
165		-	Received by the Office of the Governor this _______ _____________
166		-	day of ___________________, 20_______, at _______ o'clock _______ M.
167		-	By: _______________________________ __
168		-	Approved by the Governor of the State of Oklahoma this _____ ____
169		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
170		-
171		-	_____________________________ ____
172		-	Governor of the State of Oklahoma
173		-
174		-
175		-	OFFICE OF THE SECRETARY OF STATE
176		-	Received by the Office of the Secretary of State this _______ ___
177		-	day of __________________, 20 _______, at _______ o'clock _______ M.
178		-	By: _______________________________ __
	261	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 04/01/2021 - DO
	262	+	PASS, As Coauthored.