Bill > SB448

This bill establishes comprehensive requirements for health carriers (insurance companies) regarding the processing and payment of healthcare claims in Montana. The legislation defines key terms and creates a structured framework for prompt claim payment, specifying that electronic claims must be paid within 14 calendar days and paper claims within 30 calendar days. A "clean claim" is defined as a claim with no defects or missing documentation, and health carriers are required to provide clear notification within 10-15 days if a claim is considered incomplete. If health carriers fail to pay clean claims within the specified timeframe, they must pay interest at a rate based on the treasury securities rate plus 0.1 percentage points. The bill also establishes significant penalties for non-compliance, including civil penalties up to $25,000 per violation and an additional $10,000 per week that a violation continues. Importantly, the bill provides both administrative enforcement mechanisms through the insurance commissioner and a private right of action for individuals who are adversely affected, allowing aggrieved parties to seek declaratory or injunctive relief after providing written notice and waiting 90 days. The law will apply to claims filed on or after January 1, 2026, giving health carriers time to adjust their processes to meet the new requirements.

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https://bills.legmt.gov/#/laws/bill/2/LC3197