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standardized claim form for professional or facility services, as | | applicable, approved by the Federal Government and submitted | | electronically. An insurer may not be required to accept a claim | | submitted on a form other than the applicable form specified in | | this section and may not be required to accept a claim that is not | | submitted electronically, except from a health care practitioner | | who is exempt pursuant to Title 24, section 2985. |
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| | | Sec. D-8. 24-A MRSA §4235, as amended by PL 2003, c. 218, §8, is | | further amended to read: |
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| | | §4235. Standardized claim forms |
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| | | All health maintenance organizations providing payment or | | reimbursement for diagnosis or treatment of a condition or a | complaint by a licensed physician or chiropractor health care | | practitioner must accept the current standardized claim form for | | professional services approved by the Federal Government and | | submitted electronically. All health maintenance organizations | | providing payment or reimbursement for diagnosis or treatment of | | a condition or a complaint by a licensed hospital must accept the | | current standardized claim form for professional or facility | | services, as applicable, approved by the Federal Government and | | submitted electronically. A health maintenance organization may | | not be required to accept a claim submitted on a form other than | | the applicable form specified in this section and may not be | | required to accept a claim that is not submitted electronically, | | except from a health care practitioner who is exempt pursuant to | | Title 24, section 2985. |
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| | | Sec. D-9. Effective date. This Part takes effect October 16, 2003. |
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| | | Sec. E-1. 24 MRSA §2327, as amended by PL 2003, c. 428, Pt. E, §1, | | is further amended to read: |
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| | | A group health care contract may not be issued by a nonprofit | | hospital or medical service organization in this State until a | | copy of the group rates to be used in calculating the premium for | | these contracts has been filed for informational purposes with | | the superintendent. The filing must include the base rates and a | | description of any procedures to be used to adjust the base rates | | to reflect factors including but not limited to age, gender, | | health status, claims experience, group size and coverage of | | dependents. | | Notwithstanding this section, |
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