An Act Regaidmg Timely Payment of Undisputed Insurfu~e Claims
Maine Legislature, Session 131, LD 1244
Committee Amendment CA_A_H398 (House)
Amends: 24-A MRSA §2436

FIJST SPECIAL SESSION 
I 
COMMITTEE AMENDMENT ,1/J,,," to HP 792, L D 1244, "An Act Regaidmg 
Timely Payment of Undisputed Insurfu~e Claims" 
Amend the bill by strikmg out the title and substitutmg the following 
'An Act to Define Undisputed Health Insurance Claims' 
Amend the bill by stnkmg out everything afte1 the enactmg clause and msertmg the 
followmg 
'Sec. 1. 24-A MRSA §2436, sub-§2-A, as 1epealed and teplaced by PL 2009, c 
613, §9, 1s amended to read. 
2-A. Fo1 a claim submitted by a health cate provider or health cate facility with respect 
to a heakh plan cameras defined m section 4301-A, subsection+ 1, for purposes of this 
section, "undisputed claim" means a timely claim for payment of coveted health care 
expenses that--1& must be submitted to a camer m conformity with the followmg 
reqmrements for standa1d1zed claim forms set forth m section 2753 
A The claun must be slffimltted on one of the follmvmg claims forms 
(1) For a health care facility claun submitted on paper, the standrud claim form, 
usmg standards approved by a national umform bdhng commrttee, 
(2) For a health care pro:v1der claim submitted on paper, the standB:l d ela1m form, 
usmg sta-nda.rds i¼I9pro:ved by a nat10nal uniform cl0:1m commfttee, and 
(3) 
For health care faeihty and health cm e provide1 claims submitted 
eleetromcaUy, an eleetromc form usmg Standards approved by a-B ace¼ edited 
standards committee of the l\.menca:n National Standards Instrtute 
Sec. 2. 24-A MRSA §2436, sub-§2-B, as enacted by PL 2009, c 613, §10, is 
amended to read 
2-B. 
If a claim does not conform to the requrrements specified m subseetion 
subsections 2-A and 2-C and payment 1s demed to a health care provider or health care 
fac1hty by a carrier, the health care p1ovide1 or health care fac1hty may not request payment 
Page I - 131LR1604(02) 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT" A, to HP 792, L D 1244 
from the msured 01 beneficiary and shall attempt to rectify the deficiencies with the claim 
and resubmit the claim to the earner 
Sec. 3. 24-A MRSA §2436, sub-§2-C 1s enacted to read 
2-C. For a claim submitted by a health care provider or health care facility with respect 
to a earner as defined m section 4301-A, subsection 3, for purposes of thts section, 
"undisputed claim" means a manually or electromcally submitted claim fi om a health care 
provider or health care fac1hty that 
A Contams all the required data elements necessary for accurate ad]Udtcation without 
the need for additional mformat10n, 
B 
Is not materially deficient or improper, mcludmg lackmg substantlatmg 
documentation reqmred by the earner, and 
C Has no particular or unusual chcumstances requmng special treatment that prevent 
payment from bemg made by the earner ' 
Amend the bill by relettermg or renumbermg any nonconsecutive Part lette1 or section 
number to read consecutively 
SUMMARY 
This amendment replaces the bill and changes the title The amendment adds a 
defimt10n of "undisputed claim" as it relates to claims submitted by health care prov1de1 s 
and health care faciht1es to health msurance carriers 
COMMITTEE AMENDMENT