AN ACT RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES (Requires insurers to pay electronic claims for healthcare coverage within 14 calendar days of receipt. Permits healthcare providers to dispute claim denials within 60 days and empowers the secretary of EOHHS to establish penalties for violations.)

H7941

2026 -- H 7941
========
LC004637
========

STATE OF RHODE ISLAND
IN GENERAL ASSEMBLY
JANUARY SESSION, A.D. 2026
____________
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES

Introduced By:
Representatives Hopkins, Phillips, Casimiro, and Place

Date Introduced:
February 27, 2026

Referred To:
House Health & Human Services
It is enacted by the General Assembly as follows:
1
SECTION 1. Section 27-18-61 of the General Laws in Chapter 27-18 entitled "Accident
2
and Sickness Insurance Policies" is hereby amended to read as follows:
3

27-18-61. Prompt processing of claims.
4
(a) A healthcare entity or health plan operating in the state shall pay all complete claims
5
for covered healthcare services submitted to the healthcare entity or health plan by a healthcare
6
provider or by a policyholder within forty (40) calendar days following the date of receipt of a
7
complete written claim or within
thirty (30)

fourteen (14)
calendar days following the date of
8
receipt of a complete electronic claim. Each health plan shall establish a written standard defining
9
what constitutes a complete claim and shall distribute this standard to all participating providers.
10
(b) If the healthcare entity or health plan denies or pends a claim, the healthcare entity or
11
health plan shall have
thirty (30)

fourteen (14)
calendar days from receipt of the claim to notify in
12
writing the healthcare provider or policyholder of any and all reasons for denying or pending the
13
claim and what, if any, additional information is required to process the claim. No healthcare entity
14
or health plan may limit the time period in which additional information may be submitted to
15
complete a claim.
16

(c) A healthcare provider or policyholder may seek review of a claim that has been denied
17
in part or in whole within sixty (60) days of receipt of denial. The payor shall bear the burden of
18
establishing legitimacy of denial.
19

(d) If the denial of a claim is overturned, the payor shall remit the full amount due on the

1
claim and an administrative penalty, established by the secretary of the executive office of health
2
and human services (EOHHS), reflecting the costs incurred by the healthcare provider.
3

(c)
(e)
Any claim that is resubmitted by a healthcare provider or policyholder shall be
4
treated by the healthcare entity or health plan pursuant to the provisions of subsection (a) of this
5
section.
6

(d)
(f)
A healthcare entity or health plan that fails to reimburse the healthcare provider or
7
policyholder after receipt by the healthcare entity or health plan of a complete claim within the
8
required timeframes shall pay to the healthcare provider or the policyholder who submitted the
9
claim, in addition to any reimbursement for healthcare services provided, interest which shall
10
accrue at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day
11
after receipt of a complete electronic claim or on the forty-first (41st) day after receipt of a complete
12
written claim, and ending on the date the payment is issued to the healthcare provider or the
13
policyholder.
14

(e)
(g)
Exceptions to the requirements of this section are as follows:
15
(1) No healthcare entity or health plan operating in the state shall be in violation of this
16
section for a claim submitted by a healthcare provider or policyholder if:
17
(i) Failure to comply is caused by a directive from a court or federal or state agency;
18
(ii) The healthcare entity or health plan is in liquidation or rehabilitation or is operating in
19
compliance with a court-ordered plan of rehabilitation; or
20
(iii) The healthcare entity or health plan’s compliance is rendered impossible due to matters
21
beyond its control that are not caused by it.
22
(2) No healthcare entity or health plan operating in the state shall be in violation of this
23
section for any claim: (i) Initially submitted more than ninety (90) days after the service is rendered,
24
or (ii) Resubmitted more than ninety (90) days after the date the healthcare provider received the
25
notice provided for in subsection (b) of this section; provided, this exception shall not apply in the
26
event compliance is rendered impossible due to matters beyond the control of the healthcare
27
provider and were not caused by the healthcare provider.
28
(3) No healthcare entity or health plan operating in the state shall be in violation of this
29
section while the claim is pending due to a fraud investigation by a state or federal agency.
30
(4) No healthcare entity or health plan operating in the state shall be obligated under this
31
section to pay interest to any healthcare provider or policyholder for any claim if the director of
32
business regulation finds that the entity or plan is in substantial compliance with this section. A
33
healthcare entity or health plan seeking such a finding from the director shall submit any
34
documentation that the director shall require. A healthcare entity or health plan that is found to be

LC004637 - Page 2 of 12
1
in substantial compliance with this section shall thereafter submit any documentation that the
2
director may require on an annual basis for the director to assess ongoing compliance with this
3
section.
4
(5) A healthcare entity or health plan may petition the director for a waiver of the provision
5
of this section for a period not to exceed ninety (90) days in the event the healthcare entity or health
6
plan is converting or substantially modifying its claims processing systems.
7

(f)
(h)
For purposes of this section, the following definitions apply:
8
(1) “Claim” means: (i) A bill or invoice for covered services; (ii) A line item of service; or
9
(iii) All services for one patient or subscriber within a bill or invoice.
10
(2) “Date of receipt” means the date the healthcare entity or health plan receives the claim
11
whether via electronic submission or as a paper claim.
12
(3) “Healthcare entity” means a licensed insurance company or nonprofit hospital or
13
medical or dental service corporation or plan or health maintenance organization, or a contractor
14
as described in § 23-17.13-2(2) [repealed], that operates a health plan.
15
(4) “Healthcare provider” means an individual clinician, either in practice independently
16
or in a group, who provides healthcare services, and otherwise referred to as a non-institutional
17
provider.
18
(5) “Healthcare services” include, but are not limited to, medical, mental health, substance
19
abuse, dental, and any other services covered under the terms of the specific health plan.
20
(6) “Health plan” means a plan operated by a healthcare entity that provides for the delivery
21
of healthcare services to persons enrolled in those plans through:
22
(i) Arrangements with selected providers to furnish healthcare services; and/or
23
(ii) Financial incentive for persons enrolled in the plan to use the participating providers
24
and procedures provided for by the health plan.
25
(7) “Policyholder” means a person covered under a health plan or a representative
26
designated by that person.
27
(8) “Substantial compliance” means that the healthcare entity or health plan is processing
28
and paying ninety-five percent (95%) or more of all claims within the time frame provided for in
29
subsections (a) and (b) of this section.
30

(g)
(i)
Any provision in a contract between a healthcare entity or a health plan and a
31
healthcare provider that is inconsistent with this section shall be void and of no force and effect.
32

(j) Failure of a healthcare entity or healthcare plan to comply with this section shall
33
constitute a violation subject to penalty as determined by the secretary of the EOHHS.
34

(k) The secretary of the EOHHS shall promulgate rules, regulations, and penalty schedules

LC004637 - Page 3 of 12
1
necessary to carry out the provisions of this section.
2
SECTION 2. Section 27-19-52 of the General Laws in Chapter 27-19 entitled "Nonprofit
3
Hospital Service Corporations" is hereby amended to read as follows:
4

27-19-52. Prompt processing of claims.
5
(a) A healthcare entity or health plan operating in the state shall pay all complete claims
6
for covered healthcare services submitted to the healthcare entity or health plan by a healthcare
7
provider or by a policyholder within forty (40) calendar days following the date of receipt of a
8
complete written claim or within
thirty (30)

fourteen (14)
calendar days following the date of
9
receipt of a complete electronic claim. Each health plan shall establish a written standard defining
10
what constitutes a complete claim and shall distribute this standard to all participating providers.
11
(b) If the healthcare entity or health plan denies or pends a claim, the healthcare entity or
12
health plan shall have
thirty (30)

fourteen (14)
calendar days from receipt of the claim to notify in
13
writing the healthcare provider or policyholder of any and all reasons for denying or pending the
14
claim and what, if any, additional information is required to process the claim. No healthcare entity
15
or health plan may limit the time period in which additional information may be submitted to
16
complete a claim.
17

(c) A healthcare provider or policyholder may seek review of a claim that has been denied
18
in part or in whole within sixty (60) days of receipt of denial. The payor shall bear the burden of
19
establishing legitimacy of denial.
20

(d) If the denial of a claim is overturned, the payor shall remit the full amount due on the
21
claim and an administrative penalty, established by the secretary of the executive office of health
22
and human services (EOHHS), reflecting the costs incurred by the healthcare provider.
23

(c)
(e)
Any claim that is resubmitted by a healthcare provider or policyholder shall be
24
treated by the healthcare entity or health plan pursuant to the provisions of subsection (a) of this
25
section.
26

(d)
(f)
A healthcare entity or health plan that fails to reimburse the healthcare provider or
27
policyholder after receipt by the healthcare entity or health plan of a complete claim within the
28
required timeframes shall pay to the healthcare provider or the policyholder who submitted the
29
claim, in addition to any reimbursement for healthcare services provided, interest that shall accrue
30
at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt
31
of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written
32
claim, and ending on the date the payment is issued to the healthcare provider or the policyholder.
33

(e)
(g)
Exceptions to the requirements of this section are as follows:
34
(1) No healthcare entity or health plan operating in the state shall be in violation of this

LC004637 - Page 4 of 12
1
section for a claim submitted by a healthcare provider or policyholder if:
2
(i) Failure to comply is caused by a directive from a court or federal or state agency;
3
(ii) The healthcare provider or health plan is in liquidation or rehabilitation or is operating
4
in compliance with a court-ordered plan of rehabilitation; or
5
(iii) The healthcare entity or health plan’s compliance is rendered impossible due to matters
6
beyond its control that are not caused by it.
7
(2) No healthcare entity or health plan operating in the state shall be in violation of this
8
section for any claim: (i) Initially submitted more than ninety (90) days after the service is rendered,
9
or (ii) Resubmitted more than ninety (90) days after the date the healthcare provider received the
10
notice provided for in § 27-18-61(b); provided, this exception shall not apply in the event
11
compliance is rendered impossible due to matters beyond the control of the healthcare provider and
12
were not caused by the healthcare provider.
13
(3) No healthcare entity or health plan operating in the state shall be in violation of this
14
section while the claim is pending due to a fraud investigation by a state or federal agency.
15
(4) No healthcare entity or health plan operating in the state shall be obligated under this
16
section to pay interest to any healthcare provider or policyholder for any claim if the director of the
17
department of business regulation finds that the entity or plan is in substantial compliance with this
18
section. A healthcare entity or health plan seeking such a finding from the director shall submit any
19
documentation that the director shall require. A healthcare entity or health plan that is found to be
20
in substantial compliance with this section shall after this submit any documentation that the
21
director may require on an annual basis for the director to assess ongoing compliance with this
22
section.
23
(5) A healthcare entity or health plan may petition the director for a waiver of the provision
24
of this section for a period not to exceed ninety (90) days in the event the healthcare entity or health
25
plan is converting or substantially modifying its claims processing systems.
26

(f)
(h)
For purposes of this section, the following definitions apply:
27
(1) “Claim” means:
28
(i) A bill or invoice for covered services;
29
(ii) A line item of service; or
30
(iii) All services for one patient or subscriber within a bill or invoice.
31
(2) “Date of receipt” means the date the healthcare entity or health plan receives the claim
32
whether via electronic submission or has a paper claim.
33
(3) “Healthcare entity” means a licensed insurance company or nonprofit hospital or
34
medical or dental service corporation or plan or health maintenance organization, or a contractor

LC004637 - Page 5 of 12
1
as described in § 23-17.13-2(2), that operates a health plan.
2
(4) “Healthcare provider” means an individual clinician, either in practice independently
3
or in a group, who provides healthcare services, and referred to as a non-institutional provider.
4
(5) “Healthcare services” include, but are not limited to, medical, mental health, substance
5
abuse, dental, and any other services covered under the terms of the specific health plan.
6
(6) “Health plan” means a plan operated by a healthcare entity that provides for the delivery
7
of healthcare services to persons enrolled in those plans through:
8
(i) Arrangements with selected providers to furnish healthcare services; and/or
9
(ii) Financial incentive for persons enrolled in the plan to use the participating providers
10
and procedures provided for by the health plan.
11
(7) “Policyholder” means a person covered under a health plan or a representative
12
designated by that person.
13
(8) “Substantial compliance” means that the healthcare entity or health plan is processing
14
and paying ninety-five percent (95%) or more of all claims within the time frame provided for in §
15
27-18-61(a) and (b).
16

(g)
(i)
Any provision in a contract between a healthcare entity or a health plan and a
17
healthcare provider that is inconsistent with this section shall be void and of no force and effect.
18

(j) Failure of a healthcare entity or healthcare plan to comply with this section shall
19
constitute a violation subject to penalty as determined by the secretary of the EOHHS.
20

(k) The secretary of the EOHHS shall promulgate rules, regulations, and penalty schedules
21
necessary to carry out the provisions of this section.
22
SECTION 3. Section 27-20-47 of the General Laws in Chapter 27-20 entitled "Nonprofit
23
Medical Service Corporations" is hereby amended to read as follows:
24

27-20-47. Prompt processing of claims.
25
(a) A healthcare entity or health plan operating in the state shall pay all complete claims
26
for covered healthcare services submitted to the healthcare entity or health plan by a healthcare
27
provider or by a policyholder within forty (40) calendar days following the date of receipt of a
28
complete written claim or within
thirty (30)

fourteen (14)
calendar days following the date of
29
receipt of a complete electronic claim. Each health plan shall establish a written standard defining
30
what constitutes a complete claim and shall distribute the standard to all participating providers.
31
(b) If the healthcare entity or health plan denies or pends a claim, the healthcare entity or
32
health plan shall have
thirty (30)

fourteen (14)
calendar days from receipt of the claim to notify in
33
writing the healthcare provider or policyholder of any and all reasons for denying or pending the
34
claim and what, if any, additional information is required to process the claim. No healthcare entity

LC004637 - Page 6 of 12
1
or health plan may limit the time period in which additional information may be submitted to
2
complete a claim.
3

(c) A healthcare provider or policyholder may seek review of a claim that has been denied
4
in part or in whole within sixty (60) days of receipt of denial. The payor shall bear the burden of
5
establishing legitimacy of denial.
6

(d) If the denial of a claim is overturned, the payor shall remit the full amount due on the
7
claim and an administrative penalty, established by the secretary of the executive office of health
8
and human services (EOHHS), reflecting the costs incurred by the healthcare provider.
9

(c)
(e)
Any claim that is resubmitted by a healthcare provider or policyholder shall be
10
treated by the healthcare entity or health plan pursuant to the provisions of subsection (a) of this
11
section.
12

(d)
(f)
A healthcare entity or health plan which fails to reimburse the healthcare provider or
13
policyholder after receipt by the healthcare entity or health plan of a complete claim within the
14
required timeframes shall pay to the healthcare provider or the policyholder who submitted the
15
claim, in addition to any reimbursement for healthcare services provided, interest that shall accrue
16
at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt
17
of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written
18
claim, and ending on the date the payment is issued to the healthcare provider or the policyholder.
19

(e)
(g)
Exceptions to the requirements of this section are as follows:
20
(1) No healthcare entity or health plan operating in the state shall be in violation of this
21
section for a claim submitted by a healthcare provider or policyholder if:
22
(i) Failure to comply is caused by a directive from a court or federal or state agency;
23
(ii) The healthcare entity or health plan is in liquidation or rehabilitation or is operating in
24
compliance with a court-ordered plan of rehabilitation; or
25
(iii) The healthcare entity or health plan’s compliance is rendered impossible due to matters
26
beyond its control that are not caused by it.
27
(2) No healthcare entity or health plan operating in the state shall be in violation of this
28
section for any claim: (i) Initially submitted more than ninety (90) days after the service is rendered,
29
or (ii) Resubmitted more than ninety (90) days after the date the healthcare provider received the
30
notice provided for in § 27-18-61(b); provided, this exception shall not apply in the event
31
compliance is rendered impossible due to matters beyond the control of the healthcare provider and
32
were not caused by the healthcare provider.
33
(3) No healthcare entity or health plan operating in the state shall be in violation of this
34
section while the claim is pending due to a fraud investigation by a state or federal agency.

LC004637 - Page 7 of 12
1
(4) No healthcare entity or health plan operating in the state shall be obligated under this
2
section to pay interest to any healthcare provider or policyholder for any claim if the director of the
3
department of business regulation finds that the entity or plan is in substantial compliance with this
4
section. A healthcare entity or health plan seeking such a finding from the director shall submit any
5
documentation that the director shall require. A healthcare entity or health plan that is found to be
6
in substantial compliance with this section shall after this submit any documentation that the
7
director may require on an annual basis for the director to assess ongoing compliance with this
8
section.
9
(5) A healthcare entity or health plan may petition the director for a waiver of the provision
10
of this section for a period not to exceed ninety (90) days in the event the healthcare entity or health
11
plan is converting or substantially modifying its claims processing systems.
12

(f)
(h)
For purposes of this section, the following definitions apply:
13
(1) “Claim” means: (i) A bill or invoice for covered services; (ii) A line item of service; or
14
(iii) All services for one patient or subscriber within a bill or invoice.
15
(2) “Date of receipt” means the date the healthcare entity or health plan receives the claim
16
whether via electronic submission or has a paper claim.
17
(3) “Healthcare entity” means a licensed insurance company or nonprofit hospital or
18
medical or dental service corporation or plan or health maintenance organization, or a contractor
19
as described in § 23-17.13-2(2), that operates a health plan.
20
(4) “Healthcare provider” means an individual clinician, either in practice independently
21
or in a group, who provides healthcare services, and referred to as a non-institutional provider.
22
(5) “Healthcare services” include, but are not limited to, medical, mental health, substance
23
abuse, dental, and any other services covered under the terms of the specific health plan.
24
(6) “Health plan” means a plan operated by a healthcare entity that provides for the delivery
25
of healthcare services to persons enrolled in the plan through:
26
(i) Arrangements with selected providers to furnish healthcare services; and/or
27
(ii) Financial incentive for persons enrolled in the plan to use the participating providers
28
and procedures provided for by the health plan.
29
(7) “Policyholder” means a person covered under a health plan or a representative
30
designated by that person.
31
(8) “Substantial compliance” means that the healthcare entity or health plan is processing
32
and paying ninety-five percent (95%) or more of all claims within the time frame provided for in §
33
27-18-61(a) and (b).
34

(g)
(i)
Any provision in a contract between a healthcare entity or a health plan and a

LC004637 - Page 8 of 12
1
healthcare provider that is inconsistent with this section shall be void and of no force and effect.
2

(j) Failure of a healthcare entity or healthcare plan to comply with this section shall
3
constitute a violation subject to penalty as determined by the secretary of the EOHHS.
4

(k) The secretary of the EOHHS shall promulgate rules, regulations, and penalty schedules
5
necessary to carry out the provisions of this section.
6
SECTION 4. Section 27-41-64 of the General Laws in Chapter 27-41 entitled "Health
7
Maintenance Organizations" is hereby amended to read as follows:
8

27-41-64. Prompt processing of claims.
9
(a) A healthcare entity or health plan operating in the state shall pay all complete claims
10
for covered healthcare services submitted to the healthcare entity or health plan by a healthcare
11
provider or by a policyholder within forty (40) calendar days following the date of receipt of a
12
complete written claim or within
thirty (30)

fourteen (14)
calendar days following the date of
13
receipt of a complete electronic claim. Each health plan shall establish a written standard defining
14
what constitutes a complete claim and shall distribute this standard to all participating providers.
15
(b) If the healthcare entity or health plan denies or pends a claim, the healthcare entity or
16
health plan shall have
thirty (30)

fourteen (14)
calendar days from receipt of the claim to notify in
17
writing the healthcare provider or policyholder of any and all reasons for denying or pending the
18
claim and what, if any, additional information is required to process the claim. No healthcare entity
19
or health plan may limit the time period in which additional information may be submitted to
20
complete a claim.
21

(c) A healthcare provider or policyholder may seek review of a claim that has been denied
22
in part or in whole within sixty (60) days of receipt of denial. The payor shall bear the burden of
23
establishing legitimacy of denial.
24

(d) If the denial of a claim is overturned, the payor shall remit the full amount due on the
25
claim and an administrative penalty, established by the secretary of the executive office of health
26
and human services (EOHHS), reflecting the costs incurred by the healthcare provider.
27

(c)
(e)
Any claim that is resubmitted by a healthcare provider or policyholder shall be
28
treated by the healthcare entity or health plan pursuant to the provisions of subsection (a) of this
29
section.
30

(d)
(f)
A healthcare entity or health plan that fails to reimburse the healthcare provider or
31
policyholder after receipt by the healthcare entity or health plan of a complete claim within the
32
required timeframes shall pay to the healthcare provider or the policyholder who submitted the
33
claim, in addition to any reimbursement for healthcare services provided, interest that shall accrue
34
at the rate of twelve percent (12%) per annum commencing on the thirty-first (31st) day after receipt

LC004637 - Page 9 of 12
1
of a complete electronic claim or on the forty-first (41st) day after receipt of a complete written
2
claim, and ending on the date the payment is issued to the healthcare provider or the policyholder.
3

(e)
(g)
Exceptions to the requirements of this section are as follows:
4
(1) No healthcare entity or health plan operating in the state shall be in violation of this
5
section for a claim submitted by a healthcare provider or policyholder if:
6
(i) Failure to comply is caused by a directive from a court or federal or state agency;
7
(ii) The healthcare entity or health plan is in liquidation or rehabilitation or is operating in
8
compliance with a court-ordered plan of rehabilitation; or
9
(iii) The healthcare entity or health plan’s compliance is rendered impossible due to matters
10
beyond its control that are not caused by it.
11
(2) No healthcare entity or health plan operating in the state shall be in violation of this
12
section for any claim: (i) Initially submitted more than ninety (90) days after the service is rendered,
13
or (ii) Resubmitted more than ninety (90) days after the date the healthcare provider received the
14
notice provided for in § 27-18-61(b); provided, this exception shall not apply in the event
15
compliance is rendered impossible due to matters beyond the control of the healthcare provider and
16
were not caused by the healthcare provider.
17
(3) No healthcare entity or health plan operating in the state shall be in violation of this
18
section while the claim is pending due to a fraud investigation by a state or federal agency.
19
(4) No healthcare entity or health plan operating in the state shall be obligated under this
20
section to pay interest to any healthcare provider or policyholder for any claim if the director of the
21
department of business regulation finds that the entity or plan is in substantial compliance with this
22
section. A healthcare entity or health plan seeking that finding from the director shall submit any
23
documentation that the director shall require. A healthcare entity or health plan that is found to be
24
in substantial compliance with this section shall submit any documentation the director may require
25
on an annual basis for the director to assess ongoing compliance with this section.
26
(5) A healthcare entity or health plan may petition the director for a waiver of the provision
27
of this section for a period not to exceed ninety (90) days in the event the healthcare entity or health
28
plan is converting or substantially modifying its claims processing systems.
29

(f)
(h)
For purposes of this section, the following definitions apply:
30
(1) “Claim” means: (i) A bill or invoice for covered services; (ii) A line item of service; or
31
(iii) All services for one patient or subscriber within a bill or invoice.
32
(2) “Date of receipt” means the date the healthcare entity or health plan receives the claim
33
whether via electronic submission or as a paper claim.
34
(3) “Healthcare entity” means a licensed insurance company or nonprofit hospital or

LC004637 - Page 10 of 12
1
medical or dental service corporation or plan or health maintenance organization, or a contractor
2
as described in § 23-17.13-2(2) [repealed] that operates a health plan.
3
(4) “Healthcare provider” means an individual clinician, either in practice independently
4
or in a group, who provides healthcare services, and is referred to as a non-institutional provider.
5
(5) “Healthcare services” include, but are not limited to, medical, mental health, substance
6
abuse, dental, and any other services covered under the terms of the specific health plan.
7
(6) “Health plan” means a plan operated by a healthcare entity that provides for the delivery
8
of healthcare services to persons enrolled in the plan through:
9
(i) Arrangements with selected providers to furnish healthcare services; and/or
10
(ii) Financial incentive for persons enrolled in the plan to use the participating providers
11
and procedures provided for by the health plan.
12
(7) “Policyholder” means a person covered under a health plan or a representative
13
designated by that person.
14
(8) “Substantial compliance” means that the healthcare entity or health plan is processing
15
and paying ninety-five percent (95%) or more of all claims within the time frame provided for in §
16
27-18-61(a) and (b).
17

(g)
(i)
Any provision in a contract between a healthcare entity or a health plan and a
18
healthcare provider that is inconsistent with this section shall be void and of no force and effect.
19

(j) Failure of a healthcare entity or healthcare plan to comply with this section shall
20
constitute a violation subject to penalty as determined by the secretary of the EOHHS.
21

(k) The secretary of the EOHHS shall promulgate rules, regulations, and penalty schedules
22
necessary to carry out the provisions of this section.
23
SECTION 5. This act shall take effect upon passage.
========
LC004637
========

LC004637 - Page 11 of 12
EXPLANATION
BY THE LEGISLATIVE COUNCIL
OF
A N A C T
RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
***
1
This act would require insurers to pay electronic claims for healthcare coverage within
2
fourteen (14) calendar days of receipt. This act would further permit healthcare providers to dispute
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claim denials within sixty (60) days. This act would empower the secretary of the EOHHS to
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establish penalties for violations of this section.
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This act would take effect upon passage.
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LC004637
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LC004637 - Page 12 of 12