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Bills adjusting payments for health insurance claims pass House and Senate unanimously

Friday, February 26, 2010 | 12:01 a.m. CST; updated 9:49 a.m. CDT, Tuesday, April 13, 2010

JEFFERSON CITY — As the summit on national health care raged in Washington on Thursday, a pair of bills in Missouri that would more quickly put insurance money into the pockets of medical care providers unanimously passed the House and Senate.

The bills would force insurance companies to pay claims faster and would define what sorts of claims should be the easiest to process.

Rep. Timothy Jones, R-Eureka, the sponsor of the House's version, said he believed the bill would eventually result in lowered health care costs because it would get rid of inefficiencies in the system, and because "providers are not going to have to spend manpower and time chasing down these claims that previously were not paid."

Jones said the bill would clear up current ambiguities in the payment of health care insurance claims across the state.

"Ultimately, what this is going to do is provide a lot of certainty for both the providers — whether they're rural or urban — and the health insurance companies — big and small — in order to pay claims," he said. 

Opponents of the legislation, however, said claim-paying is a very complicated process and that health insurers must consider premium rates. The opponents include America's Health Insurance Plans, Missouri Insurance Coalition, Blue Cross Blue Shield of Kansas City and Anthem Blue Cross Blue Shield of Missouri.

Jones' bill defines a "clean claim," which means those claims that have been filed correctly. As a result, nothing should prevent timely payment.

In addition, the proposal, called "prompt pay" by some legislators, bans the indefinite suspension of "clean claims," so insurance companies must either deny the claim or pay such claim in 45 days. It also creates a penalty — one percent of the claim per day — for overdue, unpaid claims.

The bill stipulates if an insurance company still does not feel it has a valid claim after 45 days, it can deny the claim and "the parties can go to the historical methods they've had of arbitration," Jones said. "Or, if they have to sue on their contracts, they can do that as well."

Gov. Jay Nixon expressed his support for the bill and commended the chambers for their bipartisanship.

A statement emailed by Nixon's office on Wednesday said "This legislation will help make sure that Missouri's health care providers, hospitals and rural doctors will be paid more quickly for the services they provide to their patients."

Last year, Nixon's office commissioned the Department of Insurance to study insurance company payment of claims to health care providers.

"The report recommends Missouri law be strengthened to make the medical claims process more efficient, by providing clear direction to both insurers and health care providers on their roles and responsibilities," John M. Huff, Department of Insurance director told Nixon in a letter dated Dec. 31, 2009.

"While many insurers are meeting their financial obligations to providers, others are not," Huff wrote. 

In a statement following Thursday's vote, Jones said the Department of Insurance's recommendations were a basis for the legislation.

The House and Senate appear to be on the same page, with the Senate passing its version of the bill on the same day as the House.

Sen. Jim Lembke, R-Mehlville, sponsored a prompt pay bill for the third year. The bill passed the Senate the last two years, but never made it through the House.

The House and Senate will now begin looking at the other chamber's bill.


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