(1) Except for claims involving organ transplants, each insurer shall reimburse a provider for a clean claim or send a written or an electronic notice denying or contesting the claim within thirty (30) calendar days from the date that the claim is received by the insurer or any entity that administers or processes claims on behalf of the insurer. Clean claims involving organ transplants shall be paid, denied, or contested within sixty (60) calendar days from the date that the claim is received by the insurer or any entity that administers or processes claims on behalf of the insurer.
(2) Within the applicable claims payment time frame, an insurer shall:
(a) Pay the total amount of the claim in accordance with any contract between the insurer and the provider;
(b) Pay the portion of the claim that is not in dispute and notify the provider, in writing or electronically, of the reasons the remaining portion of the claim will not be paid; or
(c) Notify the provider, in writing or electronically, of the reasons no part of the claim will be paid.
Effective: July 15, 2002
History: Amended 2002 Ky. Acts ch. 181, sec. 12, effective July 15, 2002. — Created
2000 Ky. Acts ch. 436, sec. 2, effective July 14, 2000.