SCS/SB 445 - This act provides stricter prompt pay requirements for insurance companies.

Currently, provider/health carrier agreements are outlined in Section 354.606, RSMo. A new subsection 9 is added to prohibit any contract between a provider and health carrier from mandating the use of a hospitalist. A "hospitalist" is defined as a physician who becomes the physician of record for a patient of a participating provider. The hospitalist may return care to the participating provider when the patient is released from the hospital.

Currently, Section 376.383, RSMo, requires claim reimbursement within forty-five days or a notice stating reasons for refusal. After April 1, 2002, new language requires a specific description of the additional information required in order to process a claim. Currently, a carrier must pay interest if a claim is not paid within forty-five days. New language allows the carrier to combine interest payments into one payment when it reaches five dollars. Finally, new language allows any person who files a claim for a service to also file a civil action against the health carrier for violations of this section. No action, however, may be filed until ten days after notifying the health carrier of the intent to sue.

A new Section 376.386 provides additional duties for health carriers, including permitting providers to file uniform confirmation numbers and to file reimbursement claims for up to one year. As of January 1, 2003, providers may accept electronically filed claims and issue prompt confirmation of receipt. Health carriers must accept all codes included in the physician's current procedural terminology and must provide current fee schedules. They may not request a refund more than one year after paying a claim. Internet access to current provider directories must be provided. Enrollees must be informed of coverage denials and must receive an enrollee card with all pertinent information.

Portions of this act are substantially similar to SB 367, SB 395, SCS/HB 544 and TAT SCS/HS/HCS/HBs 328 & 88 (2001).
ERIN MOTLEY