Ohio § 3901.383 Contractual agreements for payments by third-party payers

Ohio Statutes

§ 3901.383 — Contractual agreements for payments by third-party payers

Ohio § 3901.383

Title 39Insurance

Ch. 3901Superintendent Of Insurance

This text of Ohio § 3901.383 (Contractual agreements for payments by third-party payers) is published on Counsel Stack Legal Research, covering Ohio primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ohio Rev. Code Ann. § 3901.383 (2026).

Text

(A)A provider and a third-party payer may do either of the following:

(1)Enter into a contractual agreement under which time periods shorter than those set forth in section3901.381of the Revised Code are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider;

(2)Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly related to the receipt of a claim form. The contractual arrangement may include periodic interim payment arrangements, capitation payment arrangements, or other periodic payment arrangements acceptable to the provider and the third-party payer. Under a capitation payment arrangement, the third-party payer shall begin paying the capitated amounts to t

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(A) A provider and a third-party payer may do either of the following:

(1) Enter into a contractual agreement under which time periods shorter than those set forth in section3901.381of the Revised Code are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider;

(2) Enter into a contractual agreement under which the timing of payments by the third-party payer is not directly related to the receipt of a claim form. The contractual arrangement may include periodic interim payment arrangements, capitation payment arrangements, or other periodic payment arrangements acceptable to the provider and the third-party payer. Under a capitation payment arrangement, the third-party payer shall begin paying the capitated amounts to the beneficiary's primary care provider not later than sixty days after the date the beneficiary selects or is assigned to the provider. Under any other contractual periodic payment arrangement, the contractual agreement shall state, with specificity, the timing of payments by the third-party payer.

(B) Regardless of whether a third-party payer is exempted under division (D) of section3901.3814from sections3901.38and3901.381to3901.3813of the Revised Code, a provider and the third-party payer, including a third-party payer that provides coverage under the medicaid program, shall not enter into a contractual arrangement under which time periods longer than those provided for in paragraph (c)(1) of 42 C.F.R.447.46are applicable to the third-party payer in paying a claim for any amount due for health care services rendered by the provider.