§ 23-99-1705 — Claims

(a) A contracting entity shall pay a claim for ambulance services for which prior authorization was received regardless of the terminology used by the transportation benefit manager or health benefit plan within thirty (30) days of receipt of the claim from an ambulance provider, unless: (1) Authorized ambulance services were never performed; or (2) There is specific information available for review by the appropriate state or federal agency that the subscriber or ambulance provider has engaged in material misrepresentation, fraud, or abuse regarding the claim for the authorized ambulance services. (b) (1) A healthcare insurer or transportation benefit manager shall pay two hundred fifty percent (250%) of the Medicare Ambulance Fee Schedule, Rural Rate for a claim for ambulance services to an ambulance provider. (2) An ambulance provider shall accept the payment under subdivision (b)(1) of this section as payment in full for services provided to the subscriber. (3) An ambulance provider shall not balance bill or otherwise demand a payment from the subscriber other than a deductible, copayment, or coinsurance required under the subscriber's health benefit plan. (c) Ambulance services authorized or guaranteed for payment under this section for which the prior authorization is not rescinded or reversed under subsection (a) of this section are not subject to audit recoupment. (d) A claim submitted by an ambulance provider shall include any information as required by the Insurance Commissioner.

Legislative History

Added by Act 2023, No. 578,§ 1, eff. 8/1/2023.