SB249 Alabama 2012 Session

Summary

Primary Sponsor

Tom Whatley

Republican

Session

Regular Session 2012

Title

Health care providers, certain health insurers, health maintenance organizations, statewide claim-dispute-resolution program established, Health Department to administer

Summary

This bill would create a statewide, third-party claim-dispute resolution program for health care providers and certain health insurers/ HMOs, overseen by the Department of Public Health.

What This Bill Does

It sets up a program where a contracted resolution organization reviews unresolved claim disputes between providers and health benefit plans and makes recommendations to the Department of Public Health. The department must adopt rules and then implement the program, and final department orders follow the resolution organization's recommendations. The bill also outlines eligibility, timelines, documentation rules, penalties for noncompliance, and annual reporting on outcomes.

Who It Affects

• Health care providers may file disputes and must provide requested documentation within set deadlines.
• Health benefit plans (including health insurers, HMOs, and self-insured plans) may be respondents in disputes and must participate and provide documentation; they may be subject to defaults and penalties.

Key Provisions

• Establishes a statewide claim-dispute-resolution program by Jan 1, 2013 and contracts with a resolution organization to review disputes and recommend resolutions to the Department of Public Health.
• Defines terms: department, health benefit plan, provider, and resolution organization; outlines which disputes are eligible or ineligible for review (with several exclusions).
• Requires requests and supporting documents from both sides within 15 days of request, with possible extensions, and requires submission of supporting documents or the dispute can be dismissed or defaulted.
• If the resolution organization finds a party in default, it can recommend a default against that party for the full amount plus interest; the nonprevailing party pays the review cost, with penalties for late payment.
• The department may monitor compliance, report patterns of noncompliance to licensure/certification entities, and must prepare an annual report to the Governor and Legislature with relevant statistics.
• The resolution organization must issue a written recommendation with findings of fact within 60 days (not to exceed 90 days) after receiving information, and the department must adopt that recommendation as a final order within 30 days.
• The department must notify licensure or certification entities of violations of final orders and may require exhaustion of internal dispute processes before submission in some cases.

AI-generated summary using openai/gpt-5-nano on Feb 25, 2026. May contain errors — refer to the official bill text for accuracy.

Subjects

Health Care Providers