Rhode Island House Bill H5165

Rhode Island 2023 Regular Session

• Introduced: 1/19/23
• Refer: 1/19/23

Caption

Board Of Medical Licensure And Discipline -- Prompt Processing Of Insurance Claims

Impact

The implications of H5165 extend significantly into the state's health care regulations, potentially reshaping how insurers handle claims and interact with both policyholders and medical providers. Health care entities will be required to adhere to a standardized definition of a complete claim, and they must communicate any denials effectively within a designated period. This bill aims to foster transparency in the insurance process and ensure prompt processing of claims, thereby decreasing the financial strain on healthcare providers who often face delays in reimbursement. Such reforms are expected to enhance the operational efficiency of health care delivery within Rhode Island.

Summary

House Bill H5165 is a legislative proposal aimed at reforming the way health insurance claims are processed in Rhode Island. The bill mandates that health care entities and health plans must pay all complete claims for covered health care services within specified timeframes, including forty calendar days for written claims and thirty calendar days for electronic claims. This is intended to expedite the reimbursement process for health care providers and enhance compliance with established guidelines. Additionally, the bill includes provisions that prohibit health care entities from denying claims solely based on their association with motor vehicle accidents or other third-party claims, thereby safeguarding the rights of policyholders and ensuring that legitimate claims are honored.

Contention

Notably, H5165 has been a point of contention among stakeholders, especially with concern around the requirements that could be seen as burdensome for insurers. While advocates of the bill, including health care providers, argue that timely processing of claims is essential for sustainable medical practice, insurers may argue that the bill imposes restrictive deadlines that fail to consider complex claims processing scenarios. The balance between ensuring provider needs and allowing insurers sufficient latitude to process claims accurately remains a critical aspect of the discussions surrounding this bill.