Claims Settlement Practices & Dispute Resolution
The Claims Settlement Practices and Dispute Mechanisms Regulations were approved by the Office of Administrative Law on July 24, 2003, and are effective August 25, 2003. The Quarterly Claims Settlement Practices Report is required to be submitted for each licensed health care service plan. Health care service plans report claim information if the plan or any of its capitated providers has failed to timely reimburse at least 95% of complete claims with correct payment including interest and penalties due, that became payable during the reporting period.
The links below are to view the Annual Plan Claims Payment and Dispute Resolution Mechanism Report and the Quarterly Claims Settlement Practices Report. Also provided is a link to instructions for completing these reports. The reports were effective as of quarter 1, 2006. Please note the additional reporting requirements are effective as of quarter 4, 2006.