23 CAR § 15-109 – Claim filing requirements of health carriers

(a) The provisions of this section shall only apply to persons that are defined as health carriers under 23 CAR § 15-103(b)(8).
(b) Every health carrier upon receipt of any written inquiry from the State Insurance Department respecting a claim shall within fifteen (15) working days of such inquiry furnish the department with a reasonably adequate response to the inquiry.
(c) If, after receipt of a complaint, the Insurance Commissioner determines that a health carrier’s claim filing requirements are unreasonable or unduly burdensome, the commissioner shall direct the health carrier to discontinue using such claim filing requirements.
(d) A health carrier shall provide a copy of its claim filing requirements to a:
1. (1) Contracted provider at the time the health carrier and provider enter into their contract and within fifteen (15) days prior to a change to the claim filing requirements; and
2. (2) Health insured or provider upon request, within fifteen (15) days.