CO SB124

Expands the definition of "intermediary" to include persons conducting utilization management, utilization review, provider credentialing, claims processing, reimbursement rate negotiation, network development, and disease management on behalf of carriers.

Requires intermediaries responsible for claims processing to comply with prompt payment standards equivalent to those applied to carriers, with the insurance commissioner authorized to investigate complaints from providers.

Prohibits intermediaries from using covered persons' insurance benefits for administrative costs, altering medical codes or provider charges, modifying contracts without written consent, denying reimbursement to contracted providers meeting plan requirements, or retaliating against providers for disclosing information to covered persons.

Requires intermediaries to inform covered persons that utilization reviews are performed by the intermediary and establishes that willful violations of these prohibitions constitute unfair methods of competition and unfair or deceptive acts in insurance.

Takes effect January 1, 2014, subject to voter approval if a referendum petition is filed within 90 days of final adjournment.