806 KAR 17:310. Prompt payment of claims reporting requirements

Link to law: http://www.lrc.ky.gov/kar/806/017/310.htm
Published: 2015

      806 KAR 17:310. Prompt payment of claims

reporting requirements.

 

      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),

304.17A-722(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

benefits.

 

      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

KRS 304.17A-700(3).

      (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

304.17A-005(27).

      (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

3(1).

 

      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

claims.

      (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

shall:

      (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

regulation.

 

      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.)
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