An Act To Save the Health Care System Money by Ensuring Timely Denials of Claims
Maine Legislature, Session 122, LD 0600
Committee: Insurance and Financial Services
Sponsors: GLYNN, SHIELDS, ROSEN
Amends: 22 MRSA §3, 24-A MRSA §4303

Legislative Document 
No. 600 
H.P.433 
House of Representatives, February 3, 2005 
An Act To Save the Health Care System Money by Ensuring Timely 
Denials of Claims 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative GLYNN of South Portland. 
7J1~ 
/J7·17Id£~ 
MILLICENT M. MacFARLAND 
Clerk 
Cosponsored by Representative: SHIELDS of Auburn, Senator: ROSEN of Hancock. 
PriIII<d on recycled paper 
Be it enacted by the People of the State of Maine as follows: 
Sec. I. 22 MRSA §3I74-GG is enacted to read: 
§3l14-GG. 
Timely pa~nt of claims; coordination of benefits 
with primary payor 
If a health 
care--llrovig~_r has not received payment from 
Q 
carrier, as defined in Title 24-A, section 430l-A, 
subsecti~ 
that is the primary payor of a claim for more than 90 days after 
submission of an 
electronic_QL--P-9J2-~aimL--t~-provideL_mg.'y 
assume that a carrier who is 
.the~rimary payor has denied __ the 
claim and submit that claim 
for_--p-g.-ym~nt_ to the MaineCill_El.---PL-Q9X.a.m 
if MaineCare gualifies as a secondary payor of the claim. 
Th~ 
MaineCare program shall pay~be cJaim and must be 
reimburse~L_for 
any payments made in accordance with this section i.f a carr ier 
pays the claim or any part of thE;LclaJ-l!Lafter 90 dQYJL __ 
Sec. 2. 24-A MRSA §4303. sub-§10-A is enacted to read: 
lO-A. 
Timely p~nt of claims; 
coordinatio~ of 
benefit~" 
A carrier offering a 
health plan 
:in this State that is 
tl}~ 
pr imary payor of a 
claim may not 
del~for more than 90 days 
payment of an undisputed claim or~~art of an undisputed cla.im 
as defined in section 2436, 
subsection 2-A. 
After 
days, 
a 
provider may assume that a carrier who is the primary payor has 
denied the claim and submit that claim for payment to a secondary 
payor, administrator or carrier~ including but not limited to the 
MaineCare and Medicare programs. 
If a carrier pays the claim or 
any part of the claim after 90 days, the provider is responsible 
for any reimbursement to the secondary -p.ayor, administrator or 
carrier for payments made in accordance with this subsection. 
A 
carrier shall report annually to the superintendent on or after 
March 31st the total claims that have not been paid wi thin 90 
days during the preceding calendar year and the general reasons 
why payment of those claims has been delayed. 
SUMMARY 
This bill requires a health insurance carrier that is the 
primary payor 
of 
an 
undisputed 
insurance 
claim to 
make 
the 
payment within 90 days. If the payment is not made, 
the bill 
permits 
a 
health care provider to 
assume the claim has been 
denied and submit that claim to a secondary payor such as the 
MaineCare or Medicare program. 
The bill requires the MaineCare 
program to pay claims submitted by a provider that have not been 
paid by the primary carrier within 90 days if MaineCare qualifies 
as a secondary payor of the claim. 
The bill also requires that a 
health 
care 
provider 
reimburse 
the 
secondary 
payor 
for 
any 
Page l-LR076l(l) 
payments if the 
The bill also 
claims not paid 
pr imary carrier pays 
di~ects carriers to 
within 90 days and the 
any claims after 90 days. 
report annually regarding 
reasons for the delays.