(ii) Supplies in writing to the provider the specific reasons why the
legitimacy of the claim, or a portion of the claim, or the appropriate amount of
reimbursement is in dispute;

(iii) Pays any undisputed portion of the claim within 30 days of the
receipt of the claim; and

(iv) Makes a good faith, timely effort to resolve the dispute.

(d) A health maintenance organization shall permit a provider a minimum of 6
months from the date a covered service is rendered to submit a claim for
reimbursement for the service.

(e) (1) If a health maintenance organization notifies a provider that
additional documentation is necessary to adjudicate a claim, the health maintenance
organization shall reimburse the provider for covered services within 30 days after
receipt of all reasonable and necessary documentation.

(2) If a health maintenance organization fails to comply with the
requirements of paragraph (1) of this subsection, the health maintenance
organization shall pay interest in accordance with the requirements of subsection (b)
of this section.

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
June 1, 1999.

Approved May 13, 1999.

CHAPTER 472
(House Bill 639)

AN ACT concerning

Health Insurance - Payment of Claims

FOR the purpose of requiring insurers, nonprofit health service plans, and health
maintenance organizations, for certain claims for reimbursement, to send
certain notice of receipt and statue of the claim within a certain period of time
after receipt of the claim repealing certain provisions of law relating to the
payment of certain claims for reimbursement by health maintenance
organizations and managed care organizations; making certain provisions of law
relating to payment of claims that are applicable to insurers and nonprofit
health service plans also applicable to health maintenance organizations and
managed care organizations; and generally relating to payment of claims under
health—insurance by insurers, nonprofit health service plans, health
maintenance organizations, and managed care organizations.

BY repealing and reenacting, with amendments,

Article - Insurance