Kentucky Statutes 304.17A-705 – Electronic claims submission
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(1) As used in this section, “insurer” has the same meaning as in KRS § 304.17A-005.
(2) Any contract between an insurer and its pharmacy benefits administrator that requires claims to be submitted electronically shall require that payment is to be made electronically to the participating provider or its designee for clean claims submitted electronically, if electronic payment is requested by the provider.
(3) Any contract between an insurer and a participating pharmacy or its contracting agency that requires claims to be submitted electronically shall require that payment is to be made electronically to the participating provider or its designee for clean claims submitted electronically, if electronic payment is requested by the provider.
(4) An electronic claim shall be submitted in the form required by the insurer if the participating provider or designee agrees to accept claims details for these payments electronically and provides accurate electronic funds transfer information to the insurer.
(5) All electronic claims shall be in compliance with the provisions of 45 C.F.R. Part
142.
(6) The provisions of this section shall apply to all contracts in subsections (2) and (3) of this section that are entered into, amended, extended, or renewed on or after January 1, 2009.
Effective: July 15, 2008
History: Created 2008 Ky. Acts ch. 40, sec. 1, effective July 15, 2008.
Legislative Research Commission Note (7/15/2008). The House Committee Substitute for 2008 HB 551 intended to change the word “carrier” to “insurer” throughout. One instance of “carrier” at the end of subsection (4) of this statute was inadvertently not changed. This manifest clerical or typographical error has been corrected by the Reviser of Statutes in codifying 2008 Ky. Acts ch. 40, sec. 1, under the authority of KRS § 7.136(1)(h).
(2) Any contract between an insurer and its pharmacy benefits administrator that requires claims to be submitted electronically shall require that payment is to be made electronically to the participating provider or its designee for clean claims submitted electronically, if electronic payment is requested by the provider.
Terms Used In Kentucky Statutes 304.17A-705
- Committee substitute: Short for committee amendment in the nature of a substitute.
- Contract: A legal written agreement that becomes binding when signed.
- Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
- Insurer: means any insurance company. See Kentucky Statutes 304.17A-005
- provider: means any:
(a) Advanced practice registered nurse licensed under KRS Chapter 314. See Kentucky Statutes 304.17A-005 - Statute: A law passed by a legislature.
(3) Any contract between an insurer and a participating pharmacy or its contracting agency that requires claims to be submitted electronically shall require that payment is to be made electronically to the participating provider or its designee for clean claims submitted electronically, if electronic payment is requested by the provider.
(4) An electronic claim shall be submitted in the form required by the insurer if the participating provider or designee agrees to accept claims details for these payments electronically and provides accurate electronic funds transfer information to the insurer.
(5) All electronic claims shall be in compliance with the provisions of 45 C.F.R. Part
142.
(6) The provisions of this section shall apply to all contracts in subsections (2) and (3) of this section that are entered into, amended, extended, or renewed on or after January 1, 2009.
Effective: July 15, 2008
History: Created 2008 Ky. Acts ch. 40, sec. 1, effective July 15, 2008.
Legislative Research Commission Note (7/15/2008). The House Committee Substitute for 2008 HB 551 intended to change the word “carrier” to “insurer” throughout. One instance of “carrier” at the end of subsection (4) of this statute was inadvertently not changed. This manifest clerical or typographical error has been corrected by the Reviser of Statutes in codifying 2008 Ky. Acts ch. 40, sec. 1, under the authority of KRS § 7.136(1)(h).