36-3411. Behavioral health services; timely
reimbursement; penalties
A. The division shall ensure that behavioral health service providers are
reimbursed within ninety days after the service provider submits a clean claim to a
regional behavioral health authority.
B. Any contract issued by or on behalf of the division for the provision of
behavioral health services shall include language outlining provisions for penalties for
noncompliance with contract requirements.
C. If the regional behavioral health authority does not reimburse a provider as
required by this section, the director shall subject the regional behavioral health
authority to the penalty provisions prescribed in the contract which shall not exceed the
interest charges prescribed in section 44-1201, subsection A. The director shall impose
any financial penalties levied upon the regional behavioral health authority through a
reduction in the amount of funds payable to the regional behavioral health authority for
administrative expenses.
D. The ninety day deadline imposed by this section is suspended while a formal
grievance regarding the legitimacy of a claim is pending.
E. The department or a regional behavioral health authority shall not pay claims
for covered services that are initially submitted more than nine months after the date of
the services for which payment is claimed or that are submitted as clean claims more than
twelve months after the date of service for which payment is claimed. A person
dissatisfied with the denial of a claim by the department or by the regional behavioral
health authority has twelve months from the date of the service for which payment is
claimed to institute a grievance against the department or regional behavioral health
authority.
F. For claims paid by the department, either directly or through a third party
payor, the director may impose a penalty on a regional behavioral health authority or a
service provider who submits a claim to the department for payment more than one time
after the same claim had been previously denied by the department without having
attempted to address the reason given for the denial. The penalty imposed by the director
shall not exceed the average cost incurred by the department for processing a claim and
shall be levied upon the regional behavioral health authority or service provider through
reducing any future payment or payments until the amount of the penalty has been paid.
G. This section does not apply to services provided by a hospital pursuant to
section 36-2903.01, subsection G or H, or section 36-2904, subsection H or I.
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