Amends TCA Title 56.

Present law requires, no later than 21 calendar days after receiving a claim by electronic submission, a health insurance entity to:<br /> <br /> (1) If the claim is clean, pay the total covered amount of the claim;<br /> (2) Pay the portion of the claim that is clean and not in dispute and notify the provider why the remaining portion of the claim will not be paid; or<br /> (3) Notify the provider of the reason why the claim is not clean and will not be paid and what substantiating documentation or information is required to adjudicate the claim.<br /> <br /> This bill reduces from 21 to 14 calendar days the time within which a health insurance entity must pay a claim or provide notice as required in (1) - (3) above.<br /> <br /> This bill requires, no later than 10 calendar days after receiving a claim by electronic submission for a service that was approved under a health insurance entity's preauthorization process before it was performed, a health insurance entity to: <br /> <br /> (A) If the entire claim was approved under the preauthorization process, pay the total covered amount of the claim; or<br /> (B) If only a portion of the claim was approved under the preauthorization process, pay the covered amount of the portion of the claim that was approved under the preauthorization process and respond to any remaining portion in accordance with (1) - (3) above, within the applicable time period as described above.<br /> <br /> This bill will not apply to TennCare.<br /> <br />