SB474 Summary

• Establishes a statewide claim-dispute-resolution program administered by the State Department of Public Health, operational by January 1, 2012, to resolve disputes between health care providers and health benefit plans.

• Requires the Department to contract with a qualified third-party resolution organization to review claim disputes and issue written recommendations with findings of fact within 60 days, with a maximum review period of 90 days.

• Excludes certain claims from the program, including those related to interest payments, Medicare/Medicaid proceedings, pending court actions, and disputes subject to pre-existing binding resolution processes.

• Imposes a 12-month filing deadline after final claim determination and requires both parties to submit supporting documentation within 15 days; failure to comply results in dismissal or default judgment.

• Requires the nonprevailing party to pay review costs to the resolution organization within 35 days, with penalties up to $500 per day for non-payment, and mandates annual reporting to the Governor and Legislature on dismissed claims and defaults.