A bill for an act relating to health carriers and payment of claims, audits, and standards of conduct; prior authorizations and utilization review organizations; and providing civil penalties and including applicability provisions.

Summary

The bill sets strict timelines for insurers to accept or deny clean claims—30 days for electronic submissions and 45 days for paper. It also establishes how insurers must conduct audits of those claims, reimburse providers for audit costs, and provides a clear appeal process. The changes apply to all health carriers, including Medicaid and the HAWKI program, and create civil penalties for violations.

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