Table of Contents

Section 1. Purpose and Scope Section 2. Standards for Minimum Interest Payments Section 3. Exceptions Section 4. Severability Section 5. Effective Date

Section 1. Purpose and Scope

This Rule is adopted by the Superintendent, pursuant to 24-A M.R.S.A. §§ 2436(3) and 212, to establish minimums for interest due on overdue undisputed claims to health care providers before an interest payment must be issued.

Section 2. Standards for Minimum Interest Payments

A. A health insurance carrier may aggregate interest owed to a health care provider on overdue undisputed claims if:

1. The health insurance carrier aggregates interest owed on all overdue claims, including claims for which the interest due is less than $2.00.

2. The health insurance carrier establishes a mechanism to respond to written inquiries from providers within 30 days regarding how much interest the provider is owed.

3. The health insurance carrier pays interest owed to a provider at least annually if the unpaid interest at the end of the year exceeds $10.00. Annual interest must be paid within 30 days of the end of the calendar or fiscal year. Whenever the interest owed to a provider exceeds $50, the health insurance carrier must comply with the requirement of subsection 2(A)(4).

4. The health insurance carrier pays interest owed to a provider at least quarterly if the aggregate interest owed at the end of the quarter exceeds $50.00. Quarterly interest must be paid within 30 days of the end of each calendar or fiscal quarter. B. If a health insurance carrier does not aggregate interest owed to a provider for overdue claims, interest must be paid on any overdue undisputed claim for which the interest payable is greater that $2.00.

Section 3. Exceptions

A. Provided interest is paid at least annually, nothing in this rule prohibits a health insurance carrier and a provider or group of providers who are paid on a capitated basis from contracting for minimum interest payments and payment periods that differ from the minimum requirements in section 2 of this rule.

B. Provided interest is paid at least annually, nothing in this rule prohibits a health insurance carrier from contracting with a hospital for minimum interest payments and payment periods that differ from the parameters described in section 2 of this rule.

C. The Superintendent may grant exceptions, for good cause, to the minimum interest payment and payment period requirements of section 2 of this rule. Requests for exceptions must be signed by both the health insurance carrier and the affected health care provider. A request for an exception is not required for contracts negotiated pursuant to section 3A and 3B of this rule.

Section 4. Severability

If any section, term, provision, or application of this Rule is adjudged invalid for any reason, such judgment shall not impair or invalidate any other section, term, provision, or application, and the remainder of this Rule shall continue in full force and effect.

Section 5. Effective Date

This Rule is effective May 16, 2006 (filing 2006-199).

STATUTORY AUTHORITY: 24-A M.R.S.A. 2436(3) and 212.