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Prompt Pay Law Set to Shift in GA

Margaret Dick Tocknell, for HealthLeaders Media, October 31, 2012

An ill wind is blowing in Georgia, and I don't mean Hurricane Sandy.

Two national healthcare organizations, America's Health Insurance Plans and the American Medical Association, are waging a battle of legal documents over an amendment to the state's existing prompt pay law that would extend prompt pay regulations from traditional insurers to include third party administrators (TPA).

The problem, according to AHIP, is that the Insurance Delivery Enhancement Act of

2011, set to take effect January 1, 2013, wades into an area where a decades-old federal law already reigns supreme. The Employee Retirement Income Security Act, commonly known as ERISA, exempts self-funded payers from state health insurance laws.

Not so fast, says the AMA, which along with the Medical Association of Georgia, has filed a petition to be added to the case as co-defendants along with Ralph Hudgens, Georgia's insurance commissioner.

In 25-words or less, the IDE Act, which was signed by Gov. Nathan Deal (D) in May 2011, says TPAs must pay clean claims within 15 days if submitted electronically and 30 days if submitted by mail.

According to a MAG advocacy brief, without the law "there is no deadline for a TPA to pay a healthcare provider or notify the healthcare provider why the claim will not be paid."

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