US Laws, Codes, Statutes & Cases

                                  TITLE  41
                                  INSURANCE
                                  CHAPTER 56
                           PROMPT PAYMENT OF CLAIMS
    41-5601.  DEFINITIONS. As used in this chapter:
    (1)  "Beneficiary" means a policyholder, subscriber, member, employer or
other person who is eligible for benefits under a contract providing hospital,
surgical, or medical expense coverage or a managed care organization policy or
agreement under which a third party payer agrees to reimburse for covered
health care services rendered to beneficiaries in accordance with the benefits
contract.
    (2)  "Date of payment" means the date the payment is sent as indicated by
the mail stamp on the envelope, by the insurer to the practitioner or facility
or to the beneficiary in the event there is not a contract for direct payment
by the insurer to the practitioner or facility, or, in the event of a wire or
other electronic funds transfer, upon acceptance by the insurer's bank of a
payment order.
    (3)  "Department" means the department of insurance.
    (4)  "Director" means the director of the department of insurance.
    (5)  "Electronic claim" means a claim that is transmitted through the use
of electronic media, which includes the internet, extranet, leased lines,
dial-up lines, private networks, and those transmissions that are physically
moved from one (1) location to another using magnetic tape, disk or compact
disk media. The claim shall contain the proper format and code sets in
accordance with the applicable implementation specifications under 45 CFR 160
et seq., and 45 CFR 162 et seq.
    (6)  "Insurer" means any insurer that sells hospital, medical, long-term
care, or vision insurance policies or certificates and managed care
organizations. For the purpose of this chapter only, "insurer" also includes a
third party administrator who makes payments to beneficiaries, practitioners
or facilities on behalf of an insurer and a hospital or professional service
corporation that provides hospital, medical, long-term care or vision health
care services.
    (7)  "Practitioner or facility" means any physician, hospital or other
person or facility licensed or otherwise authorized to furnish health care
services.
    (8)  "Receipt of claim" means the date the claim is actually received by
the insurer from the practitioner or facility or the beneficiary.
    (9)  "Submission of claim" means the date the claim is sent as indicated
by the mail stamp on the envelope, by the beneficiary, practitioner or
facility, to the insurer or the date an electronic claim is transmitted to an
insurer.