Health Insurance Commissioner Christopher F. Koller is preparing to issue new regulations on how insurers pay providers that he says will make it easier to hold insurers accountable for compliance with Rhode Island’s “prompt processing of claims” laws.
The laws require health plans to pay providers’ claims within 30 days if filed electronically or within 40 days if filed on paper, and to notify providers within 30 days of any flaws that would prevent payment of their claims so the providers can correct them.
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The law also entitles providers to 12-percent interest, accruing from the 31st or 41st day, depending on how the claim was filed, if the health plan doesn’t pay promptly.
The R.I. Department of Business Regulation has had regulations in place since 2003 to apply the laws to local insurers and providers, but there’s been enough confusion about some of the rules that several doctors have reported extensive waits for payment.
The DBR previously had exempted self-insured employers from the regulations, even though their claims are also typically processed by the health plans. Koller’s new regulations would apply the laws to them as well. UnitedHealthcare of New England has filed comments objecting to this change, saying it would violate the federal Employee Retirement Income Security Act (ERISA).
Koller’s regulations, drafted by staff lawyer John A. Cogan Jr., would also “clarify” that the laws apply not only to health plans, but also to dental insurers, licensed contractors operating health plans, out-of-state insurers and some third-party administrators.
The regulations would even add RIte Care, the state Medicaid program, to the mix. Only federal plans would be exempt. Blue Cross & Blue Shield of Rhode Island is seeking to explicitly exempt Medicare Advantage plans, which are Medicare managed-care plans run by insurers.
Overall, however, Blue Cross – which has faced criticism for delayed payments as recently as last year – supports “many of the revisions” being made, spokeswoman Kim Keough said. “Paying claims promptly has always been a priority for Blue Cross,” she said.
The Rhode Island Medical Society filed testimony last week giving its “full endorsement” of the new regulations. Lobbyist Steven R. DeToy said in an interview that they’re “incredibly well-crafted” and clarify the original intent of the law to the benefit of care providers.
A draft of the regulations is posted on Koller’s page on the DBR Web site, www.dbr.ri.gov. The deadline for comments is Aug. 1.
