Bill Text: IA SF477 | 2017-2018 | 87th General Assembly | Introduced
Bill Title: A bill for an act relating to Medicaid managed care claims. (Formerly SF 342.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2017-03-31 - Referred to Human Resources. S.J. 838. [SF477 Detail]
Download: Iowa-2017-SF477-Introduced.html
Senate File 477 - Introduced SENATE FILE BY COMMITTEE ON HUMAN RESOURCES (SUCCESSOR TO SF 342) A BILL FOR 1 An Act relating to Medicaid managed care claims. 2 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 2277SV (3) 87 pf/nh PAG LIN 1 1 Section 1. MEDICAID MANAGED CARE == UNPAID CLEAN CLAIMS == 1 2 INTEREST PENALTY == TIMELY FILING OF CLAIMS. The department of 1 3 human services shall adopt rules pursuant to chapter 17A and 1 4 shall amend Medicaid managed care contracts to require all of 1 5 the following: 1 6 1. That a managed care organization pay an interest penalty 1 7 of one and one=half percent of the claim amount or unpaid 1 8 portion of the claim amount to the person submitting the claim 1 9 for any clean claim not paid within ninety days of timely 1 10 filing. The acceptance of an underpayment by the person 1 11 filing the claim does not constitute payment in full. For the 1 12 purposes of this section, "clean claim" means a claim for which 1 13 all information required for submitting the claim is available. 1 14 2. That a managed care organization allow Medicaid 1 15 providers a timely filing period of three hundred sixty=five 1 16 days from the date of service for submission of claims. The 1 17 rules and contract amendments shall also provide that a 1 18 claim may be resubmitted or adjusted if such action is taken 1 19 within three hundred sixty=five days from the date of the last 1 20 adjudication. 1 21 EXPLANATION 1 22 The inclusion of this explanation does not constitute agreement with 1 23 the explanation's substance by the members of the general assembly. 1 24 This bill requires the department of human services (DHS) 1 25 to adopt rules pursuant to Code chapter 17A and amend Medicaid 1 26 managed care contracts to require all of the following: 1 27 1. That a managed care organization pay an interest penalty 1 28 of 1.5 percent of the claim amount or unpaid portion of the 1 29 claim amount to the person submitting the claim for any clean 1 30 claim not paid within 90 days of timely filing. The acceptance 1 31 of an underpayment by the person filing the claim does not 1 32 constitute payment in full. The bill defines "clean claim" as 1 33 a claim for which all information required for submitting the 1 34 claim is available. 1 35 2. That a managed care organization allow Medicaid 2 1 providers 365 days from the date of service to submit a claim 2 2 and also provide that a claim may be resubmitted or adjusted if 2 3 action is taken within 365 days of the last adjudication. LSB 2277SV (3) 87 pf/nh