Limitations on provisions in contracts between carriers and licensed health-care providers - methods of payment - fees - definitions
(1) As used in this section, unless the context otherwise requires:
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(1) As used in this section, unless the context otherwise requires:
(a) Billing service means a person or entity that contracts with a licensed health-care provider to:
(I) Process bills for health-care services provided by the licensed health-care provider; and
(II) Pursuant to the terms of the contract, submit bills, request reconsideration of payments, and receive payments or reimbursements for health-care services provided by the licensed health-care provider.
(b) Contract means a contract between a carrier and a licensed health-care provider for the provision of health-care services to covered persons under a health coverage plan issued by the carrier.
(c) Health-care electronic funds transfers and remittance advice transaction has the same meaning as defined in 45 CFR 162.1601 and incorporates the standards described in 45 CFR 162.1602.
(2) In a contract entered into, amended, or renewed on or after August 7, 2023, the carrier shall:
(a) Offer at least one method of payment to the licensed health-care provider that does not require an associated fee charged to the health-care provider; and
(b) Not restrict the method or form of payment to the licensed health-care provider so that the only acceptable payment method is a credit card payment.
(3) If a carrier initiates a payment to a licensed health-care provider using, or changes the payment method to, electronic funds transfer payments, including virtual credit card payments, the carrier shall:
(a) Notify the licensed health-care provider if any fee is associated with a particular payment method;
(b) Advise the licensed health-care provider of the available payment methods and provide clear instructions to the licensed health-care provider as to how to select an alternative payment method; and
(c) With each payment, remit an explanation of benefits.
(4) For any contract that is in effect on or before August 7, 2023, or that is entered into, amended, or renewed on or after August 7, 2023, a carrier that initiates a payment to a licensed health-care provider using, or changes the payment method to, a health-care electronic funds transfers and remittance advice transaction shall not charge a fee solely to transmit the payment to the licensed health-care provider unless the licensed health-care provider consents to the fee. A licensed health-care provider's billing service may charge a reasonable fee related to transaction management, data management, portal services, or other value-added services above and beyond the bank transmittal when transmitting an electronic funds transfer.
(5) The commissioner has the authority to enforce this section and impose a penalty or remedy against a person who violates this section.