LD 416
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Page 2 of 3 PUBLIC Law Chapter 97 LD 416 Title Page
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LR 1474
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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. All services provided by a health care practitioner
in an office setting must be submitted on the standardized federal
form used by noninstitutional providers and suppliers.__Services in
a nonoffice setting may be billed as negotiated between the insurer
and health care practitioner. For purposes of this section, "office
setting" means a location where the health care practitioner
routinely provides health examinations, diagnosis and treatment of
illness or injury on an ambulatory basis whether or not the office
is physically located within a facility.

 
Sec. 4. 24-A MRSA §4235, as amended by PL 2003, c. 469, Pt. D, §8
and affected by §9, is further amended to read:

 
§4235. Standardized claim forms

 
All health maintenance organizations providing payment or
reimbursement for diagnosis or treatment of a condition or a
complaint by a licensed 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. All services provided by a health care
practitioner in an office setting must be submitted on the
standardized federal form used by noninstitutional providers and
suppliers.__Services in a nonoffice setting may be billed as
negotiated between the health maintenance organization and health
care practitioner. For purposes of this section, "office setting"
means a location where the health care practitioner routinely
provides health examinations, diagnosis and treatment of illness
or injury on an ambulatory basis whether or not the office is
physically located within a facility.


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