§ 27-20.10-6. Unauthorized access to provider network contracts.
(a) It is an unfair insurance practice for the purposes of chapter 29 of this title to knowingly access or utilize a provider’s contractual discount pursuant to a provider network contract without a contractual relationship with the provider, contracting entity, or third party, as specified in this chapter.
(b) Contracting entities and third parties are obligated to comply with § 27-20.10-4(b)(2) or § 27-20.10-5(c)(1) and (2) concerning the services referenced on a remittance advice (RA) or explanation of payment (EOP). A provider may refuse the discount taken on the RA or EOP if the discount is taken without a contractual basis or in violation of these sections. However, an error in the RA or EOP may be corrected within thirty (30) days following notice by the provider.
(c) A contracting entity may not lease, rent, or otherwise grant to a third party, access to a provider network contract unless the third party accessing the healthcare contract is:
(1) A payer or third-party administrator or another entity that administers or processes claims on behalf of the payer;
(2) A preferred provider organization or preferred provider network, including a physician organization or physician-hospital organization; or
(3) An entity engaged in the electronic claims transport between the contracting entity and the payer that does not provide access to the provider’s services and discount to any other third party.
History of Section.
P.L. 2009, ch. 190, § 1; P.L. 2009, ch. 209, § 1.