SF 477 (LSB 2277SV (3) 87)

SENATE FILE 477

BY  COMMITTEE ON HUMAN RESOURCES

(SUCCESSOR TO SF 342)

A BILL FOR

An Act relating to Medicaid managed care claims.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  MEDICAID MANAGED CARE —— UNPAID CLEAN CLAIMS —— INTEREST PENALTY —— TIMELY FILING OF CLAIMS.  The department of human services shall adopt rules pursuant to chapter 17A and shall amend Medicaid managed care contracts to require all of the following: 
   1.  That a managed care organization pay an interest penalty of one and one-half percent of the claim amount or unpaid portion of the claim amount to the person submitting the claim for any clean claim not paid within ninety days of timely filing. The acceptance of an underpayment by the person filing the claim does not constitute payment in full. For the purposes of this section, “clean claim” means a claim for which all information required for submitting the claim is available.
   2.  That a managed care organization allow Medicaid providers a timely filing period of three hundred sixty-five days from the date of service for submission of claims. The rules and contract amendments shall also provide that a claim may be resubmitted or adjusted if such action is taken within three hundred sixty-five days from the date of the last adjudication.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill requires the department of human services (DHS) to adopt rules pursuant to Code chapter 17A and amend Medicaid managed care contracts to require all of the following: 
   1. That a managed care organization pay an interest penalty of 1.5 percent of the claim amount or unpaid portion of the claim amount to the person submitting the claim for any clean claim not paid within 90 days of timely filing. The acceptance of an underpayment by the person filing the claim does not constitute payment in full. The bill defines “clean claim” as a claim for which all information required for submitting the claim is available.
   2. That a managed care organization allow Medicaid providers 365 days from the date of service to submit a claim and also provide that a claim may be resubmitted or adjusted if action is taken within 365 days of the last adjudication.