SB249 Summary

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

• Resolution organization must review and issue written recommendations with findings of fact within 60 days (maximum 90 days) of receiving all requested documentation, with the department adopting the recommendation as final order within 30 days.

• Excludes from review claims related to interest payments, Medicare/Medicaid proceedings, health plans not regulated by the state, claims in pending court litigation, or claims subject to pre-existing binding dispute-resolution contracts.

• Requires parties to submit supporting documentation within 15 days of request, with failure to submit resulting in dismissal for filers or default judgment against respondents, including payment of full claim amount plus interest.

• Non-prevailing parties must pay review costs to the resolution organization within 35 days, subject to penalties of up to $500 per day for non-payment; department must report annually to Governor and Legislature on dismissed claims, defaults, and order violations.