2009 Iowa Code
Title 13 - Commerce
Subtitle 1 - Insurance and Related Regulation
CHAPTER 507B - INSURANCE TRADE PRACTICES
507B.4A - DUTY TO RESPOND TO INQUIRIES AND PROMPT PAYMENT OF CLAIM.

        507B.4A  DUTY TO RESPOND TO INQUIRIES AND PROMPT
      PAYMENT OF CLAIM.
         1.  A person shall promptly respond to inquiries from the
      commissioner.
         a.  A person's actions are deemed untimely under this
      subsection if the person fails to respond to an inquiry from the
      commissioner within thirty days of the receipt of the inquiry, unless
      good cause exists for delay.
         b.  Failure to respond to inquiries from the commissioner
      pursuant to this subsection with such frequency as to indicate a
      general business practice shall subject the person to penalty under
      this chapter.
         2. a.  An insurer providing accident and sickness insurance
      under chapter 509, 514, or 514A; a health maintenance organization;
      an organized delivery system authorized under 1993 Iowa Acts, ch.
      158, and licensed by the department of public health; or another
      entity providing health insurance or health benefits subject to state
      insurance regulation shall either accept and pay or deny a clean
      claim.
         b.  For purposes of this subsection, "clean claim" means a
      properly completed paper or electronic billing instrument containing
      all reasonably necessary information, that does not involve
      coordination of benefits for third-party liability, preexisting
      condition investigations, or subrogation, and that does not involve
      the existence of particular circumstances requiring special treatment
      that prevents a prompt payment from being made.
         c.  The commissioner shall adopt rules establishing processes
      for timely adjudication and payment of claims by insurers for health
      care benefits.  The rules shall be consistent with the time frames
      and other procedural standards for claims decisions by group health
      plans established by the United States department of labor pursuant
      to 29 C.F.R. pt.  2560 in effect on January 1, 2002.
         d.  Payment of a clean claim shall include interest at the
      rate of ten percent per annum when an insurer or other entity as
      defined in this subsection that administers or processes claims on
      behalf of the insurer or other entity fails to timely pay a claim.
         e.  This subsection shall not apply to liability insurance,
      workers' compensation or similar insurance, automobile or homeowners'
      medical payment insurance, disability income, or long-term care
      insurance.  

         2001 Acts, ch 69, §8, 39; 2001 Acts, ch 176, §71
         Referred to in § 507B.4, 507B.6, 507B.12, 514F.6