§ 22:1828 — Provider claim payment and information protection

§1828. Provider claim payment and information protection
A. As used in this Section:
(1) "Electronic funds transfer" means an electronic funds transfer through the federal
Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, as amended,
standard automated clearinghouse network.
(2) "Health insurance issuer" means an entity subject to the insurance laws and
regulations of this state, that contracts or offers to contract, or enters into an agreement to
provide, deliver, arrange for, pay for, or reimburse any of the costs for healthcare services,
including a health and accident insurance company, a health maintenance organization, a
preferred provider organization, or any similar entity.
B. Within the time period prescribed by a health insurance issuer in which the health
insurance issuer can review or audit a claim for purposes of reconsidering the validity of the
claim, if a healthcare provider submits a request orally or in writing to a health insurance
issuer, the health insurance issuer shall provide a copy of all documentation transmitted
between the healthcare provider and the health insurance issuer or their respective agents,
that is associated with a claim for payment for services. The health insurance issuer shall
provide the requested documentation within two business days of the request submitted by
the healthcare provider. A health insurance issuer may, in lieu of providing a physical copy,
provide electronic access to the provider of the documentation through the use of a provider
portal or other electronic means. All information or documentation required to be provided
by this Section to a healthcare provider by a health insurance issuer, whether by physical
copy or electronic access, shall be provided at no cost to the healthcare provider.
C.(1) Any health insurance plan issued, amended, or renewed on or after January 1,
2022, between a health insurance insurer, its contracted vendor or agent, and a healthcare
provider that covers healthcare services to a plan enrollee shall not restrict the method of
payment from the health insurance issuer or its vendor to the healthcare provider in which
the only acceptable payment method for services rendered requires the healthcare provider
to pay a transaction fee, provider subscription fee, or any other type of fee or cost in order
to accept payment from the health insurance issuer or that results in a monetary reduction in
the payment to the healthcare provider for the healthcare services rendered.
(2) If initiating or changing payments to a healthcare provider using electronic funds
transfer payments the health insurance issuer, its contracted vendor, or agent shall do both
of the following:
(a) Notify the healthcare provider if any fees are associated with a particular payment
method.
(b) Advise the provider of the available methods of payment and provide instructions
to the healthcare provider for selection of an alternative payment method that does not
require the healthcare provider to pay a transaction fee, provider subscription fee, or any
other type of fee or cost in order for the healthcare provider to accept payment from the
health insurance issuer.
D. The provisions of this Section shall not be waived by contract, and any contractual
clause in conflict with the provisions of this Section or that purport to waive the requirements
of this Section is void.
E. Any violation of the provisions of this Section shall be declared and considered
to be unfair methods of competition and unfair or deceptive acts or practices in the business
of insurance and subject to the provisions of Part IV of Chapter 7 of this Title.

Legislative History

Acts 2021, No. 434, §1.