Kansas Statutes 39-709f. Medical assistance program and managed care organizations; contract; prompt payment
Terms Used In Kansas Statutes 39-709f
- Assistance: includes such items or functions as the giving or providing of money, food assistance, food, clothing, shelter, medicine or other materials, the giving of any service, including instructive or scientific. See Kansas Statutes 39-702
- Contract: A legal written agreement that becomes binding when signed.
- Medical assistance: means the payment of all or part of the cost of necessary: (1) Medical, remedial, rehabilitative or preventive care and services that are within the scope of services to be provided under a medical care plan developed by the secretary pursuant to this act and furnished by health care providers who have a current approved provider agreement with the secretary; and (2) transportation to obtain care and services that are within the scope of services to be provided under a medical care plan developed by the secretary pursuant to this act. See Kansas Statutes 39-702
- Month: means a calendar month, unless otherwise expressed. See Kansas Statutes 77-201
- Secretary: means the secretary for children and families, unless otherwise specified. See Kansas Statutes 39-702
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Kansas Statutes 77-201
(a) Any contract between the Kansas medical assistance program and any managed care organization serving the state of Kansas shall require the processing and full payment of the allowed amount or processing and denial by the managed care organization of all clean claims within 30 days after receipt of the clean claim, and the processing and full payment of the allowed amount or processing and denial by the managed care organization of all claims within 90 days after receipt of the claim. The contract shall also include a late payment provision that requires the managed care organization to pay interest to the provider at the rate of 12% per annum for each month that the managed care organization has neither processed and fully paid the allowed amount nor processed and denied a submitted claim or clean claim after the time limits set forth in this section. The Kansas medical assistance program shall also require managed care organizations to include a provision outlining the provider’s rights under this section in the managed care organization’s contracts with providers. A provider that has a claim that remains unpaid by a managed care organization after the time limits set forth in this section may bring a direct cause of action against the managed care organization for the interest provided for in this section in addition to the amount of the unpaid claim.
(b) For the purposes of this section, the terms “claim” and “clean claim” shall be assigned the same meanings as provided by 42 C.F.R. § 447.45(b).
(c) The secretary of health and environment shall adopt rules and regulations to carry out the provisions of this section, and amendments thereto.