HB606 Summary

• Establishes a statewide claim-dispute-resolution program by January 1, 2013, allowing providers and health benefit plans to resolve unresolved claim disputes through a third-party resolution organization contracted by the State Department of Public Health.

• Resolution organization reviews claim disputes within 90 days of submission and issues written recommendations with findings of fact to the department, which must adopt the recommendation as a final order within 30 days.

• Excludes from review disputes involving interest payments, claims not meeting jurisdictional thresholds, Medicare/Medicaid proceedings, unregulated health plans, pending court cases, and disputes subject to prior binding dispute-resolution contracts.

• Requires parties to submit supporting documentation within 15 days of request or face dismissal (for claimants) or default judgment (for respondents), with defaulting entities owing full claim amount plus accrued interest.

• Nonprevailing parties pay review costs to the resolution organization as determined by department rule, with penalties up to $500 per day for failure to pay within 35 days; department must report annually to Governor and Legislature on dismissed claims, defaults, and compliance failures.