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304.17A-722 Administrative regulations on claims payment practices.
(1)
(2)
(3)
(4)
No later than ninety (90) days following July 15, 2002, the department shall
promulgate administrative regulations requiring all insurers to report information
on a calendar quarter basis on prompt payment of claims to providers, as
defined in KRS 304.17A-700, that shall be limited to the following:
(a) The number of clean claims received by the insurer, its agent, or
designee during the reporting period;
(b) The percentage of clean claims received by the insurer, its agent, or
designee that were:
1.
Adjudicated within the claims payment timeframe;
2.
Adjudicated within one (1) to thirty (30) days from the end of the
claims payment timeframe;
3.
Adjudicated within thirty-one (31) to sixty (60) days from the end of
the claims payment timeframe;
4.
Adjudicated within sixty-one (61) to ninety (90) days from the end of
the claims payment timeframe;
5.
Adjudicated more than ninety (90) days from the end of the claims
payment timeframe; and
6.
Not yet adjudicated;
(c) The percentage of clean claims received during the reporting quarter that
were paid and not denied or contested:
1.
Within the claims payment timeframe;
2.
Within one (1) to thirty (30) days from the end of the claims payment
timeframe;
3.
Within thirty-one (31) to sixty (60) days from the end of the claims
payment timeframe;
4.
Within sixty (60) to ninety (90) days from the end of the claims
payment timeframe;
5.
More than ninety (90) days from the end of the claims payment
timeframe; and
6.
Not yet paid;
(d) Amount of interest paid; and
(e) For clean claims received during the reporting quarter that were not
denied or contested, the percentage of the total dollar amount of those
claims that were paid within the claims payment timeframe.
Data required in subsection (1) of this section shall be reported for hospitals,
physicians, and all other providers, excluding pharmacies.
Insurers shall submit information required in subsection (1) of this section to
the department no later than one hundred eighty (180) days following the close
of the reporting quarter.
The department shall, as part of the market conduct survey of each insurer,
audit the insurer to determine compliance with KRS 304.17A-700 to
304.17A-730 and KRS 304.14-135 and 304.99-123. Findings shall be made
available to the public upon request.
(5)
The commissioner shall annually present to the Interim Joint Committee on
Banking and Insurance and to the Governor a report on the payment practices
of insurers and compliance with the provisions of KRS 304.17A-700 to
304.17A-730 and KRS 205.593, 304.14-135, and 304.99-123 and the
commissioner's enforcement activities, including the number of complaints
received and those acted upon by the department.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 1250, effective July 15, 2010. -Amended 2002 Ky. Acts ch. 181, sec. 16, effective July 15, 2002. -- Created
2000 Ky. Acts ch. 436, sec. 12, effective July 14, 2000.
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