S.F. _____ Section 1. Section 507B.4, subsection 3, paragraph p, Code 1 2019, is amended to read as follows: 2 p. Payment of interest. Failure of an insurer to pay 3 interest at the rate of ten percent per annum on all health 4 insurance claims that the insurer fails to timely accept 5 and pay pursuant to section 507B.4A 507B.04B , subsection 6 2 , paragraph “d” . Interest shall accrue commencing on the 7 thirty-first day after receipt of all properly completed proof 8 of loss forms. 9 Sec. 2. Section 507B.4A, Code 2019, is amended by striking 10 the section and inserting in lieu thereof the following: 11 507B.4A Duty to respond to inquiries. 12 1. A person shall promptly respond to an inquiry from the 13 commissioner. A person’s actions are deemed untimely under 14 this section if the person fails to respond to an inquiry from 15 the commissioner within thirty days of the receipt of the 16 inquiry, unless good cause exists for delay. 17 2. Failure to respond to an inquiry from the commissioner 18 pursuant to this section with such frequency as to indicate a 19 general business practice shall subject the person to penalty 20 under this chapter. 21 Sec. 3. NEW SECTION . 507B.04B Timely submission of claims 22 and prompt payment of claims. 23 1. a. For purposes of this section, unless the context 24 otherwise requires: 25 (1) “Facility” means the same as defined in section 26 514J.102. 27 (2) “Health care professional” means the same as defined in 28 section 514J.102. 29 (3) “Health care provider” or “provider” means a health care 30 professional or a facility. 31 (4) “Health care services” means the same as defined in 32 section 514J.102. 33 (5) “Health insurer” means an entity subject to the 34 insurance laws and regulations of this state, or subject to 35 -1- LSB 1492XC (8) 88 ko/rn 1/ 4

S.F. _____ the jurisdiction of the commissioner, that contracts or offers 1 to contract to provide, deliver, arrange for, pay for, or 2 reimburse any of the costs of health care services, including 3 an insurance company offering sickness and accident plans under 4 chapter 509, 514, or 514A, a health maintenance organization, 5 a nonprofit health service corporation, or any other entity 6 providing a plan of health insurance, health benefits, or 7 health services. 8 b. A health care provider shall have up to three hundred 9 sixty-five calendar days after the date of provision of health 10 care services to timely submit a claim to a health insurer for 11 the health care services provided by the provider. 12 c. A health care provider shall have up to three hundred 13 sixty-five calendar days from the date of last adjudication by 14 a health insurer to resubmit a claim for adjustment of a paid 15 claim, or for reconsideration of a denied claim. 16 d. A claim submitted by a health care provider shall not be 17 paid by a health insurer if the claim is received by the health 18 insurer two or more years from the date of provision of health 19 care services by the health care provider. 20 e. This subsection shall not apply to Medicaid providers and 21 Medicaid managed care organizations. 22 2. a. A health insurer shall either accept and pay a clean 23 claim, or deny a clean claim. 24 b. For purposes of this subsection, “clean claim” means 25 a properly completed paper or electronic billing instrument 26 containing all reasonably necessary information that does not 27 involve coordination of benefits for third-party liability, 28 preexisting condition investigations, or subrogation, and that 29 does not involve the existence of particular circumstances 30 requiring special treatment that prevents a prompt payment from 31 being made. 32 c. The commissioner shall adopt rules establishing processes 33 for timely adjudication and payment of claims by health 34 insurers. The rules shall be consistent with the time frames 35 -2- LSB 1492XC (8) 88 ko/rn 2/ 4

S.F. _____ and other procedural standards for claims decisions by group 1 health plans established by the United States department of 2 labor pursuant to 29 C.F.R. pt. 2560 in effect on January 1, 3 2020. 4 d. Payment of a clean claim shall include interest at the 5 rate of ten percent per annum when a health insurer, or an 6 entity that administers or processes claims on behalf of the 7 health insurer, fails to timely pay a claim. 8 e. This subsection shall not apply to liability insurance, 9 workers’ compensation or similar insurance, automobile or 10 homeowners’ medical payment insurance, disability income, or 11 long-term care insurance. 12 Sec. 4. Section 507B.6, subsection 1, Code 2019, is amended 13 to read as follows: 14 1. Whenever the commissioner believes that any person has 15 been engaged or is engaging in this state in any unfair method 16 of competition or any unfair or deceptive act or practice 17 whether or not defined in section 507B.4 , 507B.4A 507B.04B , or 18 507B.5 and that a proceeding by the commissioner in respect 19 to such method of competition or unfair or deceptive act or 20 practice would be in the public interest, the commissioner 21 shall issue and serve upon such person a statement of the 22 charges in that respect and a notice of a hearing on such 23 charges to be held at a time and place fixed in the notice, 24 which shall not be less than ten days after the date of the 25 service of such notice. 26 Sec. 5. Section 507B.12, subsection 1, Code 2019, is amended 27 to read as follows: 28 1. The commissioner may, after notice and hearing, 29 promulgate reasonable rules, as are necessary or proper to 30 identify specific methods of competition or acts or practices 31 which are prohibited by section 507B.4 , 507B.4A 507B.04B , or 32 507B.5 , but the rules shall not enlarge upon or extend the 33 provisions of such sections. Such rules shall be subject to 34 review in accordance with chapter 17A . 35 -3- LSB 1492XC (8) 88 ko/rn 3/ 4

S.F. _____ Sec. 6. Section 514F.6, subsection 2, paragraph b, Code 1 2019, is amended to read as follows: 2 b. “Clean claim” means the same as defined in section 3 507B.4A 507B.04B , subsection 2 , paragraph “b” . 4 EXPLANATION 5 The inclusion of this explanation does not constitute agreement with 6 the explanation’s substance by the members of the general assembly. 7 This bill relates to the timely submission of claims by 8 health care providers to health insurers. The bill defines 9 “health insurer”, “health care provider”, and “health care 10 services”. 11 The bill provides that a health care provider shall have 12 up to 365 days after the date of the provision of health care 13 services to submit a claim to a health insurer. The provider 14 has up to 365 days from the date of the last adjudication 15 by a health insurer to resubmit a claim for adjustment or 16 reconsideration. A claim submitted two or more years from the 17 date of provision of health care services shall not be paid by 18 an insurer. These provisions of the bill apply to all health 19 insurers and health care providers except Medicaid providers 20 and Medicaid managed care organizations. 21 The bill makes conforming changes. 22 -4- LSB 1492XC (8) 88 ko/rn 4/ 4