Bill would let Nebraska pursue certain health plan claims

Health plan issuers would have to respond to department requests about certain payment claims and could not reject some claims for specified reasons. These requirements cover entities that issue health plans and department claims for payment for health care items or services. The department must submit the claim within three years after the care was provided. An issuer could not deny the claim solely because of its submission date, its form or format, or missing documents at the point of sale, if the department starts enforcement within six years after submitting the claim. The issuer must provide requested information within 30 days unless it shows good cause. The department may submit a claim within three years after care is provided and must start enforcement within six years after submitting it.

Licensed and self-funded insurers would provide certain coverage information to the department when it asks. This applies to licensed insurers and employers or unions that provide self-funded employee benefit plans, for people receiving or applying for state benefits. The department may request the information to check eligibility for state benefit programs or coordinate benefits. For limited benefit policies, the information is limited to whether the person has coverage and a description of it. It may be used only to check eligibility for state benefit programs. The request must identify the person. The insurer must provide the information within 30 days unless it shows good cause. Insurers would have 30 days after the request to provide the information unless they show good cause.