31A-45-302. Provider payment information -- Notice of admissions.
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Effective 1/1/2018
31A-45-302. Provider payment information -- Notice of admissions.
(a)A managed care organization shall provide the managed care organization's network providers access to current information necessary for the network provider to determine:
(i)the effect of procedure codes on payment or compensation before a claim is submitted for a procedure;
(ii)the plans and carrier networks that the network provider is subject to as part of the contract with the managed care organization; and
(iii)in accordance with Subsection 31A-26-301.6(10)(f) , the specific rate and terms under which the network provider will be paid for health care services.
(b)The information required by Subsection (1)(a) may be provided through a website, and if requested by the network provider, notice of the updated website shall be provided by the managed care organization.
(a)A managed care organization may not require a health care provider by contract, reimbursement procedure, or otherwise to notify the managed care organization of a hospital inpatient emergency admission within a period of time that is less than one business day of the hospital inpatient admission, if compliance with the notification requirement would result in notification by the health care provider on a weekend or federal holiday.
(b)Subsection (2)(a) does not prohibit the applicability or administration of other contract provisions between a managed care organization and a network provider that require preauthorization for scheduled inpatient admissions.
Enacted by Chapter 292 , 2017 General Session