Montana Code Annotated 2019

TITLE 33. INSURANCE AND INSURANCE COMPANIES

CHAPTER 22. DISABILITY INSURANCE

Part 13. Montana Reinsurance Association Act

Eligible Health Insurer Requests For Reinsurance Payments

33-22-1317. Eligible health insurer requests for reinsurance payments. (1) An eligible health insurer shall:

(a) make requests for reinsurance payment in accordance with any requirements established by the board;

(b) provide the association with access to data according to the rules and timeline established by the board in the plan of operation or by the commissioner in the administrative rules. The data environment utilized must be compatible with the federal risk adjustment program.

(c) maintain documents and records sufficient to substantiate the requests for reinsurance payments made pursuant to this part for a period of at least 6 years;

(d) apply all managed care, utilization review, case management, preferred provider arrangements, claims processing, and other methods of operation as appropriate to each claim without regard to whether that claim is eligible for or may be paid by reinsurance;

(e) make records available upon request from the commissioner or the board for purposes of verification, investigation, audit, or other review of reinsurance payment requests; and

(f) repay to the reinsurance program account in the state special revenue fund any reinsurance overpayments as determined by the commissioner as a result of an investigation, audit, or other review.

(2) Data collected from eligible health insurers under this section is confidential and not subject to public inspection.

History: En. Sec. 12, Ch. 210, L. 2019.