806 KAR 17:310. Prompt payment of claims
RELATES TO: KRS 304.17A-005,
304.17A-700-304.17A-730, 304.17C-010-304.17C-090, 304.99-123, 2008 Acts ch.
127, Part XII, secs. 18-20
STATUTORY AUTHORITY: KRS 304.2-110(1),
NECESSITY, FUNCTION, AND CONFORMITY: KRS
304.2-110(1) authorizes the executive director to promulgate reasonable
administrative regulations necessary for or as an aid to the effectuation of
any provision of the Kentucky Insurance Code as defined in KRS 304.1-010. KRS
304.17A-722(1) requires the office to promulgate administrative regulations
establishing reporting requirements regarding the prompt payment of claims by
insurers offering a health benefit plan. EO 2008-507, effective June 16, 2008,
established the Department of Insurance and the Commissioner of Insurance as
the head of the department. This administrative regulation establishes the
reporting requirements of an insurer offering a health benefit plan and an insurer
offering a limited health service benefit plan for the provision of dental-only
Section 1. Definitions. (1)
"Adjudicate" is defined in KRS 304.17A-700(1).
(2) "Claims payment time frame"
means the period of time established in KRS 304.17A-702(1).
(3) "Clean claim" is defined in
(4) "Commissioner" means
Commissioner of Insurance.
(5) "Contested claim" means a
clean claim contested in accordance with KRS 304.17A-706(1).
(6) "Department" means
Department of Insurance.
(7) "Health care provider" or
"provider" is defined in KRS 304.17A-700(9), as amended by 2008 Ky
Acts ch. 127, Part XII, sec. 18.
(8) "Insurer" is defined in KRS
(9) "Limited health service benefit
plan" is defined in KRS 304.17C-010(5).
(10) "Paid" means the act of
payment by an insurer offering a health benefit plan or a limited health
service benefit plan for the provision of dental-only benefits, its agent or
designee of the amount required by KRS 304.17A-702(2)(a) or other appropriate
amount on the payment date as determined pursuant to 806 KAR 17:360, Section
Section 2. Insurer Offering a Health
Benefit Plan Reporting Requirements. (1) Within the time frames established in
KRS 304.17A-722(3), an insurer offering a health benefit plan shall submit to
the department, on a calendar quarter basis, a report on the prompt payment of
(2) If an insurer is unable to meet a
timeframe for reporting on the prompt payment of claims as established in this
administrative regulation because of unforeseen computer system problems, an
extension of time may be granted upon written request to the commissioner.
(3) The report required pursuant to
subsection (1) of this section shall contain the prescribed information and
data elements, as applicable, in the electronic format as prescribed by the
Prompt Payment Reporting Manual, HIPMC-CP-3.
(4) At the time of submittal, the truth
and accuracy of the report required pursuant to this section shall be certified
by an executive officer of the insurer by completing the Affidavit, HIPMC-CP-2.
Section 3. Insurer Offering a Limited
Health Service Benefit Plan Reporting Requirements. An insurer offering a
limited health service benefit plan for the provision of dental-only benefits
(1) Annually, no later than June 30 of
each year, submit a report to the office on the prompt payment of claims as
established under KRS 304.17C-090(2); and
(2) Except for Section 2(1) of this
administrative regulation, be subject to the requirements of an insurer
offering a health benefit plan as established in this administrative
Section 4. Incorporation by Reference.
(1) The following material is incorporated by reference:
(a) "Prompt Payment Reporting
Manual, HIPMC-CP-3" (7/2008); and
(b) "Affidavit, HIPMC-CP-2 (7/2008)".
(2) This material may be inspected,
copied, or obtained, subject to applicable copyright law, at the Kentucky
Department of Insurance, 215 West Main Street, Frankfort, Kentucky 40601, Monday
through Friday, 8 a.m. to 4:30 p.m. This material is also available on the department's Web site at http://doi.ppr.ky.gov. (28 Ky.R. 198;
Am. 639; 871; eff. 9-25-2001; 29 Ky.R. 1384; 1804; eff. 1-16-2003; 32 Ky.R.
967; 1397; eff. 3-3-06; 35 Ky.R. 409; 823; eff. 10-31-08.)