Strike everything after the enacting clause and insert:
"Section 1. Title 23, chapter 6, article
9, Arizona Revised Statutes, is amended by adding section 23-1062.01, to read:
START_STATUTE23-1062.01 Timely payment of medical, surgical
and hospital benefit billing; content of bills; contracts between providers and
carriers; definitions
A. An
insurance carrier, self-insured employer or claims processing representative
shall make a determination whether to deny or pay a medical bill on an accepted
claim, in whole or in part, including the decision as to the amount to pay,
within thirty days from the date the claim is accepted, if the billing is
received before the date of acceptance, or within thirty days from the date of
receipt of the billing if the billing is received after the date of
acceptance. All billing denials shall be based on REASONABLE
JUSTIFICATION. The insurance carrier, self-insured employer or
claims processing representative shall pay the approved portion of the billing
within thirty days after the determination for payment is made. If the billing
is not paid within the applicable time period, the insurance carrier,
self-insured employer or claims processing representative shall pay interest to
the health provider on the billing at a rate that is equal to the legal rate.
Interest shall be calculated beginning on the date that the payment to the
health care provider is due.
B. Any
billing by a health care provider shall include all of the following:
1. The
correct demographic patient information and claim number, if known.
2. The
correct health care provider information, including name, address, telephone
number and federal taxpayer identification number.
3. The APPROPRIATE medical coding with dollar
amounts and units clearly stated with all descriptions.
4. Clearly printed date or dates of service.
5. Legible
medical reports REQUIRED FOR each date of service if the billing is for direct
treatment of the injured worker.
C. An
insurance carrier, self-insured employer or claims processing representative is
not responsible for payment of any billings for medical, surgical or hospital
benefits provided under this chapter unless the billings are received by the
insurance carrier, self-insured employer or claims processing representative
within twelve months from the date of service or from the date on which the
health care provider knew or should have known that service was rendered on an
industrial claim.
D. An
injured worker is not responsible for payment of any portion of a medical bill
for services rendered on an accepted claim and is not responsible for payment
of any disputed amount between a health care provider and the insurance
carrier, self-insured employer or claims processing representative.
E. An
insurance carrier, self-insured employer or claims processing representative
that is subject to this chapter may establish an internal system for resolving
payment disputes and other contractual grievances with health care providers.
F. This
section does not apply to health care providers that enter into an express
written contract with the insurance carrier, the self-insured employer or a
claims processing REPRESENTATIVE that specifies the period in which approved
bills shall be paid and that includes contractual remedies for untimely bill
payment. If the contract does not include remedies for untimely
payment, payment must be made according to the provisions of the contract but
the interest penalty prescribed by subsection A shall apply to any late
payment. The commission does not have jurisdiction over DISPUTES INVOLVING
TIMELY PAYMENT OF BILLINGS UNDER CONTRACTS between the insurance carrier,
self-insured employer or claims processing REPRESENTATIVE and the health care
provider.
G. For the purposes of this section:
1. "Accepted claim" means a claim for
benefits under this chapter that has been accepted by a final notice of claim
status or final order or award of the commission.
2. "Date
of receipt" means the recipient's date stamp or electronic acknowledgement
date, or if a bill does not contain a date stamp or electronic acknowledgment
date the date of receipt is presumed to occur five days after the bill was
mailed to the recipient's address.END_STATUTE"
Amend title to conform