HB 5379
To require payment by insurers directly to the out-of-network emergency medical services agency and the prompt payment of clean claims.
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Sign in to take action- Introduced
- Passed House of Delegates
- Passed Senate
- To Governor
- Became Law
Bill overview
This bill requires West Virginia insurance companies to pay out-of-network emergency medical services agencies directly and to process clean claims within 30 days of receipt. Insurers cannot send payments to the individual patient in these cases. The bill also mandates that insurers provide written notice within 30 days if a claim is not considered ‘clean’ and explains the reason for denial or requests additional information.
Key provisions
- Insurers must pay out-of-network emergency medical services agencies directly.
- Insurers must pay clean claims for ground ambulance services within 30 days.
- Insurers cannot send payments to the covered individual for these services.
- Insurers must provide written notice within 30 days if a claim is not considered ‘clean’.
- The notice must explain the reason for denial or request additional information.
- Exceptions are provided for other payors, benefit coordination, prior payment, fraudulent claims, or material misrepresentations.
Who is affected
- Insurance companies
- Out-of-network emergency medical services agencies
- Individuals receiving ground ambulance services
- Healthcare providers
- West Virginia residents
Notable changes
- The bill establishes a 30-day timeframe for insurers to make payments.
- It clarifies that payments should be made directly to the emergency medical services agency, not the patient.
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