§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 […]
§33-46-1. Short Title
This article may be cited as the "Third-Party Administrator Act".
§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 […]
§33-44-8. Civil Relief
(a) No insurance contract entered into in violation of this article shall preclude the insured from enforcing his or her rights under the contract in accordance with the terms and provisions of the contract and the laws of this state against any unauthorized insurer or any person assisting the unauthorized insurer to the same degree […]
§33-44-9. Criminal Penalties
Any unauthorized insurer who violates the provisions of this article is guilty of a felony and, upon conviction thereof, may be fined not more than $20,000 per each unauthorized act or transaction of unauthorized insurance or confined in the state correctional facility not less than one nor more than five years, or both fined and […]