LD 1611
pg. 50
Page 49 of 73 PUBLIC Law Chapter 469 Page 51 of 73
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LR 2137
Item 1

 
§2332-E. Standardized claim forms

 
All nonprofit hospital or medical service organizations and
nonprofit health care plans providing payment or reimbursement
for diagnosis or treatment of a condition or a complaint by a
licensed physician or chiropractor health care practitioner must
accept the current standardized claim form for professional
services approved by the Federal Government and submitted
electronically. All nonprofit hospital or medical service
organizations and nonprofit health care plans 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 nonprofit hospital or medical service
organization or nonprofit health care plan 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 section 2985.

 
Sec. D-2. 24 MRSA §2985, as enacted by PL 1993, c. 477, Pt. D, §7
and affected by Pt. F, §1, is repealed and the following enacted
in its place:

 
§2985.__Billing for health care services

 
A health care practitioner, as defined in section 2502,
subsection 1-A,__who directly bills for health care services must
use the current standardized claim form for professional services
approved by the Federal Government and, after October 16, 2003,
must submit claims in electronic data format to a carrier, as
defined in Title 24-A, section 4301-A, subsection 3, that accepts
claims in an electronic format.__A health care practitioner or
group of health care practitioners with fewer than 10 full-time-
equivalent health care practitioners and other employees is
exempt from the requirement to submit claims in electronic data
format until October 16, 2005.__Beginning October 16, 2005, a
health care practitioner or group of health care practitioners
with fewer than 10 full-time-equivalent health care practitioners
and other employees may apply to the Superintendent of Insurance
for a continued exemption from the requirement to submit claims
in electronic data format based upon hardship.__The
Superintendent of Insurance shall adopt rules relating to the
process for a hardship exemption and the standard for determining
whether a practitioner has demonstrated hardship. Rules adopted
pursuant to this section are routine technical rules as defined
in Title 5, chapter 375, subchapter 2-A.


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