Relates to establishing timeframes for the payment of claims to hospitals

Bill A 8172 establishes new timeframes and processes for insurers to pay claims submitted by hospitals. It requires insurers to pay hospital claims at the contracted rate as billed, regardless of their own medical necessity or administrative policies, before any review. After payment, insurers can request a post-payment review for a limited percentage of claims by a joint committee composed of medical professionals from both the insurer and the hospital. If this committee cannot agree on the medical necessity of the services, an independent third-party review agent will make a binding determination, and hospitals must refund payments for services found not medically necessary.