§ 33-20e-10 — Dismissal of arbitration requests

(a) The Commissioner shall dismiss certain requests for arbitration if the disputed claim is: (1) Related to a healthcare plan that is not regulated by the state; (2) The basis for an action pending in state or federal court at the time of the request for arbitration; (3) Subject to a binding claims resolution process entered into prior to July 1, 2021; (4) Made against a healthcare plan subject to the exclusive jurisdiction of the Employee Retirement Income Security Act of 1974, 29 U.S.C. Sec. 1001 , et seq.; or (5) In accord with other circumstances as may be determined by department rule. (b) The Commissioner may dismiss certain requests for arbitration in the following circumstances: (1) The provider or facility has engaged in a pattern or practice of any of the following: (A) Failing to respond to the department's requests for data under Code Section 33-20E-11.1 ; (B) Failing to respond to the department's other inquires after filing requests for arbitration; or (C) Failing to pay resolution organizations as required under Code Section 33-20E-16 ; (2) The provider or facility failed to file its request for arbitration within 60 days of receipt of payment for the claim and concurrently provide the insurer with a copy of such request; or (3) The provider or facility failed to explain in detail the reasons arbitration is needed. Such explanation shall include a representation as to whether the insurer's payment was in accord with the relevant provisions of Code Sections 33-20E-4 or 33-20E-5 if the party requesting arbitration is an out-of-network provider, and Code Section 33-20E-4 if the requesting party is out-of-network facility. If such payment was in such accord, the explanation shall provide in detail the complexity and circumstances of the services provided which necessitate additional payment.

Legislative History

Amended by 2023 Ga. Laws 223,§ 4, eff. 7/1/2023. Added by 2020 Ga. Laws 470,§ 1, eff. 1/1/2021.