3 AAC 28.705 - Uniform claim forms for health insurance

(a) An insurer shall accept a properly completed claim submitted on the applicable uniform form set out in Uniform Claim Forms for Health Insurance, dated June 23, 1995 and hereby adopted by reference. A properly completed claim includes

(1) completion of a uniform claim form with information consistent with the National Uniform Billing Data Element Specifications, as developed by the National Uniform Billing Committee as of January 8, 1993 with technical corrections as of February 19, 1993; and

(2) submission of a uniform claim form on electronic media.

(b) If the information entered on the form is incomplete, the insurer may return the form to the provider for completion if necessary to process the claim.

(c) If additional information is essential to the insurer's proper handling of the claim, the insurer may seek that information by letter, investigative inquiry, or other reasonable means of communication. The insurer may not seek information duplicating what already is known to the insurer. To avoid needless delay, inquiries must be kept to a minimum.

Notes

3 AAC 28.705

Eff. 8/11/95, Register 135

Information regarding the National Uniform Billing Data Element Specifications and the National Uniform Billing Committee referenced in 3 AAC 28.705(a) (1) may be obtained from the American Hospital Association, One North Franklin, Chicago, Illinois 60606. The pamphlet Uniform Claim Forms for Health Insurance, dated June 23, 1995, may be obtained from the division of insurance, P.O. Box 110805, Juneau, Alaska 99811-0805.

Authority:AS 21.06.085

AS 21.06.090

AS 21.36.125