215 ILCS 5/368a
2021 Illinois Compiled Statutes|Chapter 215 - INSURANCE|215 ILCS 5/ - Illinois Insurance Code.|Article XX - Accident And Health Insurance

Sec. 368a. Timely payment for health care services.(a) This Section applies to insurers, health maintenance organizations,  managed care plans, health care plans, preferred provider organizations, third  party  administrators, independent practice associations, and physician-hospital  organizations (hereinafter referred to as "payors") that  provide  periodic payments, which are payments not requiring a claim, bill, capitation  encounter  data, or capitation reconciliation reports, such as  prospective capitation payments, to  health care professionals and health care facilities  to provide medical or health care services for insureds or enrollees.(1) A payor shall make periodic payments in     accordance with item (3).  Failure to make periodic payments within the period of time specified in item (3) shall entitle the health care professional or health care facility to interest at the rate of 9% per year from the date payment was required to be made to the date of the late payment, provided that interest amounting to less than $1 need not be paid.  Any required interest payments shall be made within 30 days after the payment.(2) When a payor requires selection of a health care     professional or health care facility, the selection shall be completed by the insured or enrollee no later than 30 days after enrollment.  The payor shall provide written notice of this requirement to all insureds and enrollees. Nothing in this Section shall be construed to require a payor to select a health care professional or health care facility for an insured or enrollee.(3) A payor shall provide the health care     professional or health care facility with notice of the selection as a health care professional or health care facility by an insured or enrollee and the effective date of the selection within 60 calendar days after the selection.  No later than the 60th day following the date an insured or enrollee has selected a health care professional or health care facility or the date that selection becomes effective, whichever is later, or in cases of retrospective enrollment only, 30 days after notice by an employer to the payor of the selection, a payor shall begin periodic payment of the required amounts to the insured's or enrollee's health care professional or health care facility, or the designee of either, calculated from the date of selection or the date the selection becomes effective, whichever is later. All subsequent payments shall be made in accordance with a monthly periodic cycle.(b) Notwithstanding any other provision of this Section,  independent practice associations and physician-hospital organizations shall  make periodic payment of the required amounts in  accordance with a monthly periodic schedule after  an insured or enrollee has selected a health care professional or health care  facility or after that selection becomes effective, whichever  is later.Notwithstanding any other provision of this Section, independent  practice associations and physician-hospital organizations shall make all  other payments for health services within 30 days after receipt of  due proof  of loss.  Independent  practice associations and physician-hospital organizations shall notify the  insured, insured's assignee, health care professional, or health care facility  of any failure to provide sufficient documentation for a due proof of  loss within 30 days after receipt of the claim for health services.Failure to pay within the required time period shall entitle the payee to  interest at the rate of 9% per year from the date the payment is due to the  date of the late payment, provided that interest amounting to less than $1  need not be paid.  Any required interest payments shall be made within 30  days after the payment.(c) All insurers, health maintenance  organizations, managed care plans, health care plans, preferred provider  organizations, and third party administrators  shall ensure that all claims and indemnities  concerning health care services  other than for  any periodic payment shall be paid within 30 days after receipt of due  written proof of such loss. An insured, insured's assignee, health care  professional, or health care facility shall be  notified of any known failure to provide sufficient documentation for a  due proof of  loss within 30 days after receipt of the claim for health care  services.  Failure to pay  within such period shall entitle the payee  to interest at the rate of 9% per year from the 30th day after  receipt of such proof of loss to  the date of late payment, provided that interest amounting to less than one  dollar need not be paid.  Any  required interest payments shall be made within 30 days after the payment.(d) The Department shall enforce the provisions of this Section pursuant to  the enforcement powers granted to it by law.(e) The Department is hereby granted specific authority to issue a  cease and desist order, fine, or otherwise penalize independent practice  associations and physician-hospital organizations that violate this Section.  The Department shall adopt reasonable rules to enforce compliance with this  Section by  independent practice associations and physician-hospital organizations.  (Source: P.A. 97-813, eff. 7-13-12.)