An Act To Amend the Laws Regarding Submission of Health Insurance Claims
Maine Legislature, Session 122, LD 0416
Committee: Insurance and Financial Services
Sponsors: MILLS
Amends: 24-A MRSA §1912, 24-A MRSA §2436

Legislative Document 
No. 416 
S.P. 140 
In Senate, January 27,2005 
An Act To Amend the Laws Regarding Submission of Health 
Insurance Claims 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Senator MILLS of Somerset. 
Printed on recycled paper 
JOY J. O'BRIEN 
Secretary of the Senate 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §1912, as amended by PL 2003, c. 469, Pt. 
D, §3 and affected by §9, is, further amended to read: 
§1912. Standardized claim forms 
All administrators who 
administer claims 
and who provide 
payment 
or 
reimbursement 
for 
diagnosis 
or 
treatment 
of 
a 
condition or a complaint by a licensed health care practitioner 
must accept the current standardized claim form for professional 
services 
approved 
by 
the 
Federal 
Government 
and 
submitted 
electronically. 
All administrators who administer claims and who 
provide payment or reimbursement for diagnosis or treatment of a 
condition or a complaint by a licensed hospital must accept the 
current standardized claim 
form 
for professional or facility 
services, as applicable, approved by the Federal Government and 
submitted electronically. 
An administrator may not be required 
to accept a claim submitted on a form other than the applicable 
form specified in this section and may not be required to accept 
a 
claim that is not submitted electronically, 
except 
from 
a 
health care practitioner who is exempt pursuant to Title 24, 
section 2985. 
With the eKception of claj.ms for emergency room 
services 
and pathology services, 
all claims 
for professional 
services must be submitted on the standardized federal form used 
by noninstitutional providers and suppliers to bill for Medicare 
Part B covered services. 
Sec. 2. 24-A MRSA §2436, sub-§2-A, as amended by PL 2003, c. 
469, Pt. D, §3 and affected by §9, is further amended to read: 
2-A. 
Except as provided in this subsection, for purposes of 
this section, 
an "undisputed claim" means 
a 
timely claim for 
payment 
of 
covered health care 
expenses 
under 
a 
policy 
or 
certificate providing health care coverage that is submitted to 
an insurer within 30 days of the date of service on the insurer's 
standard claim form using the most current published procedural 
codes with all the required fields completed with correct and 
complete information in accordance with the insurer's published 
claims filing requirements. 
After October 16, 
2003 
aae--1:i-st,l,± 
Ge~ege~---~9T---~QQe, 
for 
a 
provider 
with 
or 
more 
full-time-equivalent employees, 
an 
"undisputed claim" 
means 
a 
timely claim for payment of covered health care expenses under a 
policy or certificate providing health care coverage that is 
submitted to an insurer, within 30 days of the date of service, 
in the insurer's standard electronic data format using the most 
current published procedural codes with all the required fields 
completed with correct and complete information in accordance 
with the insurer's published claims filing requirements. 
This 
Page l-LR1474(1) 
subsection applies only to a policy or certificate of a health 
plan as defined in section 430l-A, subsection 7. 
SUMMARY 
This bill exempts insurers from paying interest on health 
care provider claims that are received more than 30 days after 
the date of service. 
This bill also requires that, with the 
exception 
of 
emergency 
room 
and 
pathology 
services, 
health 
insurance claims for professional services be submitted on the 
standard federal 
form 
used by noninstitutional providers 
and 
suppliers to bill for Medicare Part B covered services, also 
known 
as 
the 
"CMS 
1500" 
form, 
published by the Centers 
for 
Medicare and Medicaid Services.