§33-45-1. Definitions

As used in this article: (1) “Claim” means each individual request for reimbursement or proof of loss made by or on behalf of an insured or a provider to an insurer, or its intermediary, administrator or representative, with which the provider has a provider contract for payment for health care services under any health plan.

§33-45-2. Minimum Fair Business Standards Contract Provisions Required; Processing and Payment of Health Care Services; Provider Claims; Commissioner’s Jurisdiction

(a) Every provider contract entered into, amended, extended, or renewed by an insurer on or after August 1, 2001, shall contain specific provisions which shall require the insurer to adhere to and comply with the following minimum fair business standards in the processing and payment of claims for health care services: (1) An insurer shall […]

§33-45-3. Damages, Attorney Fees and Costs Available to Providers Upon Insurer's Violation of Article or Breach of Contract Provisions

Any provider who suffers loss as the result of an insurer's violation of any provision of this article or an insurer's breach of any provider contract provision required by this article is entitled to initiate an action to recover actual damages. The commissioner shall not be deemed to be a "trier of fact" for purposes […]

§33-45-4. Providers Invoking Rights Protected

No insurer or its network, provider panel or intermediary may terminate or fail to renew the employment or other contractual relationship with a provider, or any provider contract, or otherwise penalize any provider, for invoking any of the provider's rights under this article or under the provider contract.

§33-45-5. Commissioner Authorized to Propose Rules

The commissioner is authorized to propose rules for legislative approval in accordance with the provisions of article three, chapter twenty-nine-a of this code, to implement the provisions of this article.

§33-45-6. Commissioner's Authority

Nothing in this article shall limit or modify the commissioner's duties and authority under article two of this chapter.

§33-45-7. Contractual Alternative Reimbursement Arrangements

This article shall not apply to provider contracts in which payment is rendered by periodic, capitation or withhold payments.

§33-45-8. Exemptions

(a) The provisions of this article do not apply to claims that are not covered under the terms of the health plan. (b) Nothing in this article shall preclude the right of a provider or insurer to pursue any other administrative, civil or criminal proceedings or remedies permitted under state or federal law. (c) The […]