Section 167:4-b Health Carrier Disclosure of Third Party Liability.
I. In this section, ""health carrier'' means a health carrier as defined in RSA 420-G:2 and any health insurer; administrator of self-insured plans, group health plans, as defined in section 607(1) of the Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. section 1167(1), and service benefit plans; any third party administrator of health benefits, provider of health benefits under an ERISA plan, or provider of health benefits under a self administered plan; health management organizations, health service corporations, managed care organizations, pharmacy benefit managers, or other parties that are, by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
II. Each health carrier shall electronically cross-match claims data, policyholder, and subscriber information with the department of health and human services to provide health insurance coverage information, for third party liability purposes, regarding medical assistance recipients and applicants for medical assistance under RSA 167 in accordance with rules adopted by the commissioner of health and human services pursuant to RSA 167:3-c.
III. Such electronic cross-match shall be made by any health carrier upon certification by the department of health and human services that all persons identified on the electronic medium are applicants for or recipients of medical assistance for which the department seeks payment or reimbursement through third party liability. A health carrier shall limit the transfer of electronic cross-match information required under this section to a list of medical assistance recipients and applicants for medical assistance under RSA 167 provided to the health carrier by the department of health and human services.
IV. Any health carrier who supplies information in accordance with this section and with rules adopted under RSA 167:3-c shall have immunity from any civil or criminal liability that might otherwise be imposed or incurred.
V. Each health carrier shall:
(a) Accept the state's right of recovery and assignment to the state of any right of an individual or other entity to payment from the party for an item or service for which payment has been made under the state plan.
(b) Respond to any inquiry by the state regarding a claim for payment for any health care item or service that is submitted not later than 3 years after the date of the provision of such health care item or service.
(c) Not deny a claim submitted by the state solely on the basis of the date of submission of the claim, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale that is the basis of the claim, if:
(1) The claim is submitted by the state within the 3-year period beginning on the date on which the item or service was furnished; and
(2) Any action by the state to enforce its rights with respect to such claim is commenced within 6 years of the state's submission of such claim.
VI. A health carrier may not refuse to furnish payment, benefits, or services to an individual or refuse to enroll an individual based upon the individual's eligibility for medical assistance under Title XIX of the Social Security Act.
Source. 1999, 318:3, eff. Sept. 14, 1999. 2004, 251:6, eff. Jan. 1, 2005. 2008, 342:1, eff. Sept. 5, 2008.