House of Representatives

SB 1141

AHCCCS; claims

Sponsors: Senators Gerard, Nichols

X	Committee on Health
	Caucus and COW
	As Passed the House

SB 1141 increases time frame which a provider can appeal a claim, changes the Arizona Health Care Cost Containment System (AHCCCS) reporting date from January 30 to April 1, and makes technical and conforming changes.

History

In 1999, AHCCCS statutes relating to time frames for initial submission of claims payments were amended. The revisions to the laws reduced the time frame in which an initial submission of claims to the AHCCCS administration for payment of covered services from nine months to six months from date of service. In addition, the changes prohibited the administration from paying claims submitted by capitated providers for reinsurance more than 12 months after date of service, an increase from nine months. SB 1141 conforms the processing of claims with statutory changes made in 1999.

Provisions

· Authorizes AHCCCS to pay for claims submitted within six months of the posted eligibility date.

· Authorizes AHCCCS to pay clean claims submitted within twelve months of the posted eligibility date.

· Requires AHCCCS to pay provider’s claims for reinsurance if the claim is submitted within the period specified in the contract (eliminates current language pertaining to claims submitted more than twelve months after service).

· Extends the provider reinsurance claim appeal process from 35 days to 60 days.

· Authorizes contracted providers to pay claims that are initially submitted within six months of service or the posted eligibility date, whichever is later.

· Defines submitted.

· Changes the date of the immunization rates annual report that AHCCCS submits each year to the Governor, House Speaker, and Senate President from January 30 to April 1.

· Makes technical and conforming changes.

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· 45th Legislature

· First Regular Session 2 March 9, 2001

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