KRS 304.17A-722: Administrative regulations on claims payment practices.

(1) No later than ninety (90) days following July 15, 2002, the department shall

promulgate administrative regulations requiring all insurers to report information on

a calendar quarter basis on prompt payment of claims to providers, as defined in

KRS 304.17A-700, that shall be limited to the following:

(a) The number of clean claims received by the insurer, its agent, or designee

during the reporting period;

(b) The percentage of clean claims received by the insurer, its agent, or designee

that were:

1. Adjudicated within the claims payment timeframe;

2. Adjudicated within one (1) to thirty (30) days from the end of the claims

payment timeframe;

3. Adjudicated within thirty-one (31) to sixty (60) days from the end of the

claims payment timeframe;

4. Adjudicated within sixty-one (61) to ninety (90) days from the end of the

claims payment timeframe;

5. Adjudicated more than ninety (90) days from the end of the claims

payment timeframe; and

6. Not yet adjudicated;

(c) The percentage of clean claims received during the reporting quarter that were

paid and not denied or contested:

1. Within the claims payment timeframe;

2. Within one (1) to thirty (30) days from the end of the claims payment

timeframe;

3. Within thirty -one (31) to sixty (60) days from the end of the claims

payment timeframe;

4. Within sixty (60) to ninety (90) days from the end of the claims payment

timeframe;

5. More than ninety (90) days from the end of the claims payment

timeframe; and

6. Not yet paid;

(d) Amount of interest paid; and

(e) For clean claims received during the reporting quarter that were not denied or

contested, the percentage of the total dollar amount of those claims that were

paid within the claims payment timeframe.

(2) Data required in subsection (1) of this section shall be reported for hospitals,

physicians, and all other providers, excluding pharmacies.

(3) Insurers shall submit information required in subsection (1) of this section to the

department no later than on e hundred eighty (180) days following the close of the

reporting quarter.

(4) The department shall, as part of the market conduct survey of each insurer, audit the

insurer to determine compliance with KRS 304.17A -700 to 304.17A-730 and KRS

304.14-135 and 3 04.99-123. Findings shall be made available to the public upon

request.

(5) The commissioner shall annually present to the Interim Joint Committee on

Banking and Insurance and to the Governor a report on the payment practices of

insurers and compliance wit h the provisions of KRS 304.17A -700 to 304.17A -730

and KRS 205.593, 304.14 -135, and 304.99 -123 and the commissioner's

enforcement activities, including the number of complaints received and those acted

upon by the department.