A health maintenance organization may enter into contractual arrangements with any
other person or company for the provision, to the health maintenance organization,
of health services, insurance, reinsurance and administrative, marketing, underwriting
or other services on a nondiscriminatory basis. A health maintenance organization shall not refuse to contract with or compensate
for covered services an otherwise eligible provider solely because such provider has
in good faith communicated with one or more of his current, former or prospective
patients regarding the provisions, terms or requirements of the organization's products
as they relate to the needs of such provider's patients.
No contract between a participating provider of health care services and a health
maintenance organization shall be issued or delivered in the commonwealth unless it
contains a provision requiring that within 45 days after the receipt by the organization
of completed forms for reimbursement to the provider of health care services, the
health maintenance organization shall (i) make payments for such services provided,
(ii) notify the provider in writing of the reason or reasons for nonpayment, or (iii)
notify the provider in writing of what additional information or documentation is
necessary to complete said forms for such reimbursement. If the health maintenance organization fails to comply with this paragraph for any
claims related to the provision of health care services, said health maintenance organization
shall pay, in addition to any reimbursement for health care services provided, interest
on such benefits, which shall accrue beginning 45 days after the health maintenance
organization's receipt of request for reimbursement at the rate of 1.5 per cent per
month, not to exceed 18 per cent per year. The provisions of this paragraph relating to interest payments shall not apply to
a claim that the health maintenance organization is investigating because of suspected
fraud. No contract between a participating home health agency or a participating licensed
hospice agency and a health maintenance organization shall be issued or delivered
in the commonwealth that requires the participating home health agency or participating
licensed hospice agency to be accredited by the Joint Commission on Accreditation
of Healthcare Organizations or other national accrediting body if it is certified
for participation in the Medicare program, Title XVIII of the federal Social Security
Act, 42 U.S.C. Sections 1395 et seq.
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature or via Westlaw before relying on it for your legal needs.
Was this helpful?
Welcome to FindLaw's Cases & Codes
A free source of state and federal court opinions, state laws, and the United States Code. For more information about the legal concepts addressed by these cases and statutes, visit FindLaw's Learn About the Law.