Senate Bill No. 636 Summary

• Redefines "clean claim" to mean a claim with no defects, impropriety, lack of required documentation, or circumstances requiring special treatment that prevents timely payment.

• Requires health carriers to send electronic acknowledgment within 48 hours of receipt of electronically filed claims and provide status notice within 30 processing days (changed from 10 working days).

• Establishes that if a claim is not paid within 45 processing days, health carriers must pay one percent monthly interest plus a penalty equal to one percent of the claim per day, calculated on the unpaid balance as of day 45.

• Requires health carriers to acknowledge receipt of additional information within five calendar days or pay the claim; reduces final response time to five processing days after receiving additional information (changed from 15 working days).

• Specifies that claim denials must include specific reasons and are not valid unless communicated with stated reasons; eliminates provisions allowing carriers to "suspend" claims.

• Effective date: January 1, 2011.