Bill > H0829

This bill aims to improve the prompt payment of insurance claims by defining terms like "claim" and "complete claim" to clarify what constitutes a valid request for payment, and establishing stricter timelines for insurers to pay or deny claims, with electronic claims generally requiring payment or denial within 30 days of receipt and paper claims within 45 days. It also introduces provisions for insurers to request additional information, requiring them to consolidate such requests and respond within specific timeframes after receiving the requested documentation, and mandates that insurers cannot make serial requests for information solely to delay payment. If an insurer fails to meet these deadlines, they may be required to pay interest on the unpaid claim amount, with escalating rates if delays persist, and the bill introduces new penalties for insurers who repeatedly violate these provisions, including potentially higher fines and the possibility of license suspension or revocation for persistent violations. Furthermore, this legislation grants practitioners and facilities the right to file civil lawsuits against insurers for violations and prohibits insurers from retaliating against them for exercising their rights under this chapter, while also requiring that all provider contracts, regardless of when they were signed, must comply with these new payment standards for claims submitted after July 1, 2026, and prohibiting contracts from waiving these protections. Finally, the bill introduces transparency requirements, obligating insurers and providers to disclose when they use automated decision-making tools or similar technologies in claim processing or preparation, without requiring the disclosure of proprietary information, and clarifies that such disclosures do not automatically constitute evidence of improper practices or extend deadlines.

Business and Industry

Health and Welfare Committee (House)

https://legislature.idaho.gov/sessioninfo/2026/legislation/H0829/