62D.108 Prompt payments to home care providers. 

    Subdivision 1.    Applicability.  This section applies 
 to health maintenance organizations regulated under this chapter.

    Subd. 2.    Definitions.  For purposes of this section, 
 the following terms have the meanings given them: 

    (1) "clean claim" means an original paper or electronic 
 claim with correct data elements, prepared in accordance with 
 the health maintenance organization's published specifications 
 for claims preparation, that does not require an attachment or 
 text information to pay or deny the claim; 

    (2) "home care provider" has the meaning given in section 
 144A.43, subdivision 4; and 

    (3) "valid home care provider claim" means a clean claim 
 submitted directly to the health maintenance organization by an 
 eligible home care provider for home care services provided to 
 an eligible enrollee. 

    Subd. 3.    Claims payments to home care providers.  A 
 health maintenance organization must pay or deny a valid home 
 care provider claim for home care services within 30 days of 
 receiving the claim and all other information from third parties 
 required to process the claim in accordance with the health 
 maintenance organization's specifications for claims processing. 
 A health maintenance organization must notify a home care 
 provider of an incorrect, defective, or improper claim within 30 
 days of receipt of the original claim.  If the health 
 maintenance organization is unable to pay or deny the claim 
 within 30 days because additional information, other than 
 information from the home care provider, is required to complete 
 the processing of the claim, the health maintenance organization 
 shall disclose to the home care provider the nature of the 
 additional information needed to process the claim.  The 
 disclosure shall be made consistent with state and federal law.  
 Where evidence of suspected fraud is present, the requirement to 
 disclose additional information need not be specific. 

    Subd. 4.    Payment of interest on late payments.  (a) 
 If a health maintenance organization fails to pay or deny a 
 valid home care provider claim within 30 days as specified in 
 subdivision 3, the health maintenance organization must pay 
 interest to the home care provider on the claim with interest 
 accruing from the 30th day.  If a negotiated contract or 
 agreement between a home care provider and a health maintenance 
 organization requires an audit by the health maintenance 
 organization before acceptance and payment of the claim, 
 interest payments do not apply until 30 days after the timely 
 completion of the audit by the health maintenance organization.  
 Before any interest payment is made, the home care provider must 
 bill the health maintenance organization for the interest.  

    (b) The rate of interest paid by a health maintenance 
 organization under this subdivision shall be 1.5 percent per 
 month or any part of the month. 

    (c) A home care provider who prevails in a civil action to 
 collect interest payments from a health maintenance organization 
 shall be awarded the costs and disbursements, including attorney 
 fees, incurred in bringing the action. 

    (d) The minimum monthly interest payment that a health 
 maintenance organization must pay to a home care provider for 
 the unpaid balance for any single overdue claim equal to or 
 exceeding $100 is $10.  For unpaid balances of less than $100, 
 the health maintenance organization must pay the actual interest 
 payment due to the home care provider. 

    (e) A health maintenance organization is not required to 
 make an interest payment on a claim for which payment has been 
 delayed for purposes of reviewing potentially fraudulent or 
 abusive billing practices. 

    HIST: 1999 c 146 s 1