Know Your State Laws Regarding Managed Care Contracts
Over the past several years, many states have passed laws that provide rules that govern the contractual arrangements between Providers and Insurers. In some cases, these laws protect the provider from untimely claim payments, unforeseen uses of contractual terms by third parties and unwarranted claim denials. Such laws cover requirements for contracts between the parties, detailed claims processes and interest on untimely claim payments.
In fact, as an example, there are sections in the Kentucky Revised Statutes devoted to claims payment and utilization management. Under Kentucky law, Insurers are required to reimburse Providers for a “clean claim” within thirty (30) calendar days from the date of receipt. If this requirement is not met, interest is due on the balance of the claim at a range of 12% to 21% per annum.
Knowing your rights under the state law can assist in identifying revenue opportunities, maximizing cash flow and improving negotiations with the Insurers. If you would like more information, please contact the expert listed below at (800) 270-9629.
