Bill > SB5845

This bill aims to modernize and clarify the rules for how quickly health insurance companies, referred to as "health carriers," must pay healthcare providers and facilities for services rendered to patients. It establishes a new requirement that carriers must pay or deny a claim within 30 calendar days of receiving a "clean claim," which is a claim without any errors or missing information that would prevent payment. If a claim is not clean, the carrier must notify the provider within 21 days, explaining why it's not clean and what specific information is needed, and they generally can't ask for more information more than once. If carriers fail to meet these payment deadlines, they will be required to pay interest on the overdue amount, with the interest rate increasing over time, and this interest cannot be passed on to the patient. The bill also modifies existing rules regarding how long carriers have to request a refund from a provider for an overpayment, generally shortening these periods to 12 months (or 6 months for mental health and substance use disorder services) for most situations, and 18 months (or 9 months for mental health and substance use disorder services) when coordinating benefits with another payer. These new payment timeliness requirements will apply to health plans filed or renewed on or after January 1, 2027, with the changes to refund timelines taking effect on January 1, 2028.