ance coverage by the issuer, shall be given effect to the
extent it prevents the application of subsection (a). Such
a provision may be given effect to the extent it—
‘‘(1) requires payment to be made more
promptly than as provided in subsection (a),
‘‘(2) provides for a higher interest rate than
that provided under subsection (a), or
‘‘(3) otherwise provides for greater sanctions or
remedies in the case of a failure by a plan or issuer
to make prompt payment on claims under the plan
or under the health insurance coverage involved.
‘‘(c) CLEAN CLAIM DEFINED.—For purposes of this
section, the term ‘clean claim’ means a claim that has no
defect or impropriety (including any lack of any required
substantiating documentation) or particular circumstance
requiring special treatment that prevents timely payment
from being made on the claim under the group health plan
or health insurance coverage involved.’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 (as added by
section 603(a) of the Newborns’ and Mothers’
Health Protection Act of 1996 and amended by sec-
tion 702(a) of the Mental Health Parity Act of
1996) is amended by adding at the end the following
new section:
‘‘SEC. 713. STANDARDS RELATING TO PROMPT PAYMENT OF
PROVIDER CLAIMS.
‘‘(a) IN GENERAL.—To the extent that a group
health plan, or a health insurance issuer offering group
health insurance coverage, fails to provide for the issue,
mailing, or transmission of payment for a clean claim
within 30 calendar days after the date the plan or issuer
receives a clean claim, the plan or issuer shall provide for
payment of interest on the unpaid balance at the rate of
interest and for the same period specified in section
1842(c)(2)(C) of the Social Security Act for purposes of
part B of title XVIII of such Act.
‘‘(b) CONTRACT LIMITATIONS.—No provision of a
contract between a group health plan and a provider of
health services, or between a health insurance issuer and
a provider of health services in relation to provision of
items and services in connection with group health insur-
ance coverage by the issuer, shall be given effect to the
extent it prevents the application of subsection (a). Such
a provision may be given effect to the extent it—
‘‘(1) requires payment to be made more
promptly than as provided in subsection (a),
‘‘(2) provides for a higher interest rate than
that provided under subsection (a), or
‘‘(3) otherwise provides for greater sanctions or
remedies in the case of a failure by a plan or issuer
to make prompt payment on claims under the plan
or under the health insurance coverage involved.
‘‘(c) CLEAN CLAIM DEFINED.—For purposes of this
section, the term ‘clean claim’ means a claim that has no
defect or impropriety (including any lack of any required
substantiating documentation) or particular circumstance
requiring special treatment that prevents timely payment
from being made on the claim under the group health plan
or health insurance coverage involved.’’.
(B) Section 732(a) of such Act (29 U.S.C.
1191a(a)), as amended by section 603(b)(2) of Pub-
lic Law 104–204, is amended by striking ‘‘section
711’’ and inserting ‘‘sections 711 and 713’’.
(C) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 712 the following new item:
‘‘Sec. 713. Standards relating to prompt payment of provider claims.’’.
(b) INDIVIDUAL HEALTH INSURANCE.—Part B of
title XXVII of the Public Health Service Act (as added
by section 605(a) of the Newborn’s and Mother’s Health
Protection Act of 1996) is amended by inserting after sec-
tion 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO PROMPT PAYMENT
OF PROVIDER CLAIMS.
‘‘The provisions of section 2706 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual market in the same manner as it applies
to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small
or large group market.’’.
(c) EFFECTIVE DATES.—The amendments made by
this section shall apply with respect to payment for items
and services furnished on or after the date this is 1 year
after the date of the enactment of this Act.
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