§ 507b-4a

507B.4A Duty to respond to inquiries and prompt payment of claim. 1. A person shall promptly respond to inquiries from the commissioner.a. A person’s actions are deemed untimely under this subsection if the person fails to respond to an inquiry from the commissioner within thirty days of the receipt of the inquiry,unless good cause exists for delay. b. Failure to respond to inquiries from the commissioner pursuant to this subsection with such frequency as to indicate a general business practice shall subject the person to penaltyunder this chapter. 2. a. An insurer providing accident and sickness insurance under chapter 509, 514, or 514A; a health maintenance organization; or another entity providing health insurance orhealth benefits subject to state insurance regulation shall either accept and pay or deny aclean claim. b. For purposes of this subsection, 'clean claim' means a properly completed paper or electronic billing instrument containing all reasonably necessary information, that does notinvolve coordination of benefits for third-party liability, preexisting condition investigations,or subrogation, and that does not involve the existence of particular circumstances

tion, that does notinvolve coordination of benefits for third-party liability, preexisting condition investigations,or subrogation, and that does not involve the existence of particular circumstances requiringspecial treatment that prevents a prompt payment from being made. c. The commissioner shall adopt rules establishing processes for timely adjudication and payment of claims by insurers for health care benefits. The rules shall be consistent withthe time frames and other procedural standards for claims decisions by group health plansestablished by the United States department of labor pursuant to 29 C.F.R. pt. 2560 in effecton January 1, 2002. d. Payment of a clean claim shall include interest at the rate of ten percent per annum when an insurer or other entity as defined in this subsection that administers or processesclaims on behalf of the insurer or other entity fails to timely pay a claim. e. This subsection shall not apply to liability insurance, workers’ compensation or similar insurance, automobile or homeowners’ medical payment insurance, disability income, orlong-term care insurance.

This subsection shall not apply to liability insurance, workers’ compensation or similar insurance, automobile or homeowners’ medical payment insurance, disability income, orlong-term care insurance. 2001 Acts, ch 69, §8, 39; 2001 Acts, ch 176, §71; 2017 Acts, ch 148, §33Referred to in §507B.4, 507B.6, 507B.12, 514F.6 Sat Dec 23 00:39:17 2023 Iowa Code 2024, Section 507B.4A (20, 0)